Tag Archive for: telemedicine

Wendy Yared (ECL): “Not all cancers are inevitable, and we need to encourage everyone to understand it”

Wendy Yared at the Conference on cancer of the Swedish Presidency of the Council of the EU

INTERVIEW

There are high expectations that digital tools can contribute to a lower incidence of cancer, although we are still testing and evaluating many of them. What is certain, however, is that technology will not be enough if we do not change our lifestyle habits. We have already heard this with climate change, with the energy crisis, with our consumption patterns… and cancer is no stranger to this.

This idea is also advocated, among others, by Wendy Yared, Director of the Association of European Cancer Leagues (ECL) with more than 25 years of experience in public health and health policy. The organisation she leads brings together national and regional cancer societies that cooperate and exchange information to curb the impact of cancer at European level.

Question: In Europe, we are making great efforts to reduce the incidence of cancer, but how can we do even more?

Answer: We need to put more emphasis on cancer prevention so that we can save more lives. I am always surprised that many people are still not aware that up to 50% of all cancers are preventable. This means that not all cancers are inevitable, and we need to encourage everyone to understand it.

Why have not we paid more attention to prevention until now?

Only 3%, or even less, of health budgets are devoted to prevention. And I am not just talking about cancer prevention, but about prevention in general. When there are few resources and attention, there are not enough actions to reduce the incidence of these diseases.

Moreover, cancer takes decades to develop, so if there is a current improvement in its incidence, it is due to the efforts that were made decades ago. Maybe what we are doing now is very good and sufficient, but we will not be able to see numbers improve significantly for another twenty or thirty years. The good news is that now, at the EU level, there is a lot more attention towards cancer control and policymakers are being convinced about of its importance.

Considering the available data about the growing incidence of cancer, how is ECL looking at the future?

First, it is important to know how reliable the data and the sources are, but it is certain that the ageing of Europeans plays an important role. For our part, we are trying to maintain cancer high on the EU agenda, because this has not always been the case.

We must be patient, but there are reasons for hope, such as increased budgets for cancer control and a bigger awareness in Europe. I am confident that we will see a decrease in cancer incidence soon, especially with the increased EU support in recent years.

“I am confident that we will see a decrease in cancer incidence soon, especially with the increased EU support in recent years”.

Nowadays, it is known that our habits and the risk of suffering cancer are linked. Why is it so difficult to raise awareness of this idea among people?

Each risk factor responds to specific behaviours and, as a result, there are different challenges in each of them. For some risk factors, such as tobacco use, we have more information on why it is so hard to modify our habits, but we also know actions that work, such as taxation. If there are high prices, it will be more difficult for people, especially youth, to get hooked.

Cancer leagues need the support of governments to improve policies and raise awareness, considering that we do our best with fewer resources than industry, which widely promotes its unhealthy products (tobacco, alcohol, sugary drinks, sunbeds, etc.).

How can we convince them to lead healthier lifestyles?

The International Agency for Research on Cancer (IARC) is now in the process of updating the European Code Against Cancer. They are evaluating what works and what does not in each cancer area while considering the most updated evidence. It is important to keep renewing the messages regularly so that people are reminded of them. And finally, as mentioned before, it is important to have policies that encourage citizens to make the healthiest choices.

Can you give us some insight into the upcoming fifth version of the European Code Against Cancer and how do you plan to increase its dissemination?

There will likely be new recommendations that will be added to the current fourth edition.  Discussions are ongoing to align with current evidence, such as including boys for the Human Papilloma Virus (HPV) vaccinations.

Regarding the dissemination, we will continue to engage the member leagues of the ECL and other partner international organisations to spread the word about the ECAC, since they have direct contact with patients and civil society.

The ECAC and other initiatives focus on what we can do as individuals to reduce cancer risks, but do we ask the same commitment from producers (alcohol and tobacco companies, food industry…)?

We can ask but I have little confidence that they will have any significant level of commitment. While some companies may show that they try to make a difference, not all of them do what they promise. It is simple: it is not their job and they want to sell and make a profit. We have different priorities and that forces us to seek a balance between all the actors involved.

If producers truly wish to help, they could give a portion of their profit to support healthcare systems, because if they are going to make people sick, at least help them get better too.

“While some companies may show that they try to make a difference to reduce cancer incidence, not all of them do what they promise. It is simple: it is not their job and they want to sell and make a profit”.

In terms of digital tools for cancer care, it is very common to mention mobile apps, but can you give other examples of these tools? Is there one that stands out above the rest?

When we talk about digital tools, we also include smartwatches, the Internet of Things, robotic surgery, pathologists… but none of them stand out among the other tools for now. We have to wait for the results that all of them are promising and bringing. The internet and websites, if we count them as digital tools, are the most promising because of their accessibility, durability and reach.

How can digital tools help us to deliver cancer services more efficiently and reduce existing gaps?

The patient must be well-informed to be able to choose which option he or she prefers and to have flexibility in this regard. Beyond highlighting the benefits of these tools, such as reduced travel time and the guarantee that the doctor is always there, even if not physically, what is really important is to give the patient the possibility to choose between virtual or face-to-face care for their particular needs.

What are the barriers that healthcare professionals need to overcome?

The pandemic has shown that there is a new way of working in healthcare and has helped professionals change their mind-set on the value of digital health. Not everyone was trained with these technologies when they were studying, like surgeons, for example, so their learning curve has been steep and fast. They also have had to learn how to talk to patients through the screen when there are difficult things to tell. Professionals need to be convinced that this adaptation can be useful to them and make their work easier.

And regarding the management of health information?

Hospitals use different systems to manage their data, so harmonisation of information and platforms across healthcare institutions remains a challenge. We need to ensure that these systems are interoperable within and across our borders.

Patients can be nervous about sharing their data, because sensitive information can be grounds for discrimination if it gets out or is leaked, so these systems need to be secure and the patient needs to be assured of the confidentiality of their information.

What added value can eCAN bring in the context of digital tools?

eCAN aims to put on the table some recommendations on teleconsultation and telemonitoring at European level, which I believe is vital to clear up doubts and ensure that everyone interprets the regulations in a harmonised way. But for this to happen, it is first necessary to raise awareness among policymakers, which is also what eCAN is trying to do.

The use of telemedicine skyrocketed during the COVID-19 pandemic

The use of telemedicine, or remote clinical consultations, was limited in most countries before the pandemic, held back by regulatory barriers and hesitancy from patients and providers. In early 2020, as COVID‑19 massively disrupted in-person care, governments changed the playfield and acted decisively and broadly to promote the use of this discipline.  

Consequently, the number of teleconsultations reached unprecedented numbers, playing a vital role in maintaining access to care, but it wasn’t enough to offset reductions in face-to-face care. This is one of the conclusions reached by a recent study published by the Organisation for Economic Co-operation and Development (OECD), entitled “The COVID-19 Pandemic and the Future of Telemedicine“. 

The document also proposes policy priorities for using telemedicine in the near future like learning more about which patients are using remote care services, why they are using these services and what happens after they use them. It is as well highlighted the need to investigate whether telemedicine payment and prices are creating economic signals and incentives that promote value for money. Finally, foster integration between remote and in-person care services is needed so that these are fully coordinated and part of a seamless care pathway. 

Telemedicine before the SARS-CoV-2 

Prior to the pandemic, nine countries (Estonia, Hungary, Iceland, Ireland, Korea, Luxembourg, Mexico, Türkiye and the United States) allowed only in-person medical consultations. While it was possible to use telemedicine services in other states, many governments had specific requirements to telemedicine that effectively disincentivised its use. And although the number of services was growing in territories such as Australia, Canada and Portugal, teleconsultations were only between 0.1% and 0.2% of all appointments, according to the study. 

Among the nations that participated in the OECD Survey on Telemedicine and COVID‑19, 23 out of 31 are currently allowing teleconsultations to be performed by health workers other than doctors, six more that before the pandemic (Estonia, Germany, Iceland, Luxembourg, Portugal and the United States). 

Doctor teleconsultations in OECD countries, 2020. / OECD

Despite the rapid adoption of policies to promote the use of telemedicine, only seventeen countries state that rules and regulations governing the provision of telemedicine services are well established and clear. 

An uncertain future 

During the pandemic, eight countries (Belgium, Czech Republic, England, Estonia, Hungary, Korea, Latvia and Luxembourg) have begun paying for teleconsultations through government/compulsory schemes, and other eight (Belgium, England, Estonia, Germany, Hungary, Ireland, Latvia and Switzerland) have done the same for remote patient monitoring services. 

However, many of the changes that have enabled greater use of teleconsultations during the pandemic are temporary and have not become permanent. For example, in sixteen OECD countries, changes to regulations are transitory and subject to ongoing or periodic review, just like changes regarding financing in twelve states. 

Given the circumstances, it is unclear whether remote care substitutes for or complements in-person care, and whether telemedicine adds value when it does not deliver extra benefits and could be replaced with cheaper alternatives with identical or better outcomes.

Reference:

OECD. “The COVID-19 Pandemic and the Future of Telemedicine”. OECD Publishing (2023)

WHO publishes a guide for operating effective telemedicine services

WHO publishes a guide for operating effective telemedicine services

The World Health Organization (WHO) has recently published a guide intended for healthcare services that use telemedicine to treat their patients. The report, entitled “Consolidated telemedicine implementation guide”, addresses the key steps and considerations to implement this discipline effectively and optimize its benefits and impact.
Its content will be useful for various eCAN Work Packages, especially those that are developing the pilots and the protocol of the Joint Action, but also the ones in charge of risk mitigation, key performance indicators and stakeholders’ engagement.

“For telemedicine to have the most impact when and where it is needed, the enabling environment is critical. Investments in national policies, governance, and standards are important to have in place,” says Alain Labrique, Director of the WHO Department of Digital Health and Innovation. “This guide is not a stand-alone solution, but rather a complementary tool that works in tandem with user-centered solutions that are accessible by all, towards delivering high-quality remote care that is accountable and suitable to the context in which patients live.”

Towards the implementation of remote medicine

Aiming to be a key reference for Member States, this new resource supplements the WHO Digital Investment Implementation Guide (DIIG), which provides a systematic process for planning and implementing digital health interventions. It outlines practical steps countries can take through a process of planning, implementing, maintaining and budgeting a telemedicine programme to obtain equitable health outcomes.

“Telemedicine is an important tool that expands access to critically needed health services, but we need to be mindful of the inherent inequities where access to the technology is limited or where there is the potential for harm. This guide aims to support countries to deliver telemedicine services, while highlighting approaches to optimize and improve health for all”, comments Pascale Allotey, Director of WHO Department of Sexual and Reproductive Health and Research, whose team has contributed to the development of the guide.

Although the case studies in this guide are not from European countries, telemedicine also brings benefits to patients in the EU. This is the conclusion reached by a study published between the WHO and the Universitat Oberta de Catalunya (UOC) that analyses data from over 20.000 patients during the pandemic started in 2019. “We see better clinical outcomes, better follow-up by healthcare professionals, and an overall benefit for both patients and healthcare workers”, says David Novillo-Ortiz, Regional Adviser on Data and Digital Health and lead author of the research.

An opportunity revealed by the pandemic

The COVID-19 pandemic shone a spotlight on how telemedicine can help to deliver healthcare to all, especially for people living in remote areas and underserved communities. Countries around the world have struggled, however, to ensure routine use and long-term sustainable access to telemedicine services – even in those with the most robust health systems.

In order to ensure the sustainable use of telemedicine beyond the SARS-CoV-2 pandemic and amongst multiple complex global health challenges, from conflict and disease outbreaks to climate change, WHO has released this new resource to help guide policy-makers, decision makers, and implementers in designing and overseeing telemedicine implementations.

 

References:

Bento, P. et. al. “Consolidated telemedicine implementation guide”. World Health Organization (2022).

Saigí-Rubió F, et. al. “The Current Status of Telemedicine Technology Use Across the World Health Organization European Region: An Overview of Systematic Reviews”. J Med Internet Res (2022).