Cancer care for elderly patients: digital health
The increased familiarity of older patients with digital technologies has led to an ever growing spectrum of services being utilised in the context of cancer care. Among these technologies, a general framework is offered by telehealth support: the remote care, or remote exchange of information and even medical advice, have always been a practical alternative to in-person care, but it was primarily COVID-19 that led to its shift to the forefront.
The adoption of such services is possibly expected to be higher among the elderly, including potentially those being treated for cancer, compared to the younger generations – for practical reasons such as avoiding travel and given their chronic multiple conditions.
Regarding the corresponding engagement levels, although these are more difficult to evaluate uniformly, in some instances it has been reported that older patients do engage more. The reasons are not clear - but this phenomenon may be attributed to the fact that persons of older age groups have, in general, fewer online options to engage with, and more disposable time.
Impact for patients
For patients of older age, the evidence shows that engaging with digital health services is feasible but also increasingly common. Individuals who are already familiar with online services for other domains (e.g. public services, financial services etc) may find easier to leap towards adopting digital health solutions to manage their care and improve their daily lives. Patients with less exposure to online services face a double barrier: to adopt the mindset of utilising services available on the internet, as well as do so for perhaps their most important asset and interest: their own health.
It is not uncommon for such adoption to be facilitated through word of mouth – and the social networks of the elderly population may play an important positive role. However, while in an ideal world older cancer patients would recommend digital health solutions to their peers, these social networks have not necessarily shown to be of high cohesion or to demonstrate substantial network depth. Still, patients who are satisfied with such solutions may find it worthwhile to let others know about it – it is an important kind of peer support.
Impact for clinicians
Clinicians are, and should remain, the primary source of medical advice. On the other hand, they recognise that the state and evolution of health systems worldwide and the strain on time and resources, necessitate different avenues. It is highly important that cancer specialists are generally familiar with the existence and way of work of digital health solutions in cancer.
The optimal “digital” contribution to their patients’ health, though, would come from adopting such solutions as part of their own workflows. This is because many services encompass, beyond a patient-oriented component, one related to clinicians and their daily work. Solutions such as Remote Patient Monitoring (RPM), patient triage, medication adherence, to name a few, operate in parallel with the corresponding patient-facing support.
The abundance of such solutions must lead to an evidence-based approach towards evaluating, selecting and adopting them in a clinical setting. More trials are being undertaken in that direction.
The IMPORTANT study
Clearly, the IMPORTANT study, with its focus on elderly breast cancer patients, is one of the activities contributing towards enhanced cancer care for older patients. In its pragmatic design, it has incorporated flexibility towards patient engagement. This is particularly important given the strong interest in fragile or frail patients and the international nature of the study.
Summary
The status and the evolution of cancer care, including for older patients, includes a growing component of digital solutions. Both patients and clinicians need to stay informed and engaged (especially as the number of options is increasing) and identify the right solutions for them, based on evidence of impact and barriers to adoption.