Understanding The Role of Telemedicine in Treating Cancer

Prior to the Appointment Day

If you are seeing a health care provider for the first time, there may be forms to complete in advance of your appointment. These forms will be sent by your provider’s office via regular mail or email.

Telemedicine appointments require an internet or data connection through a computer, tablet or smartphone that has a front-facing camera. A member of your health care team will provide specific instructions on how to join the video call, including any program or application that may have to be downloaded in advance and the required login information. Ask if there is a back-up program in case the preferred program or application doesn’t work or if a phone call can be used as a last option.

Tell a member of your health care team ahead of time if a caregiver, friend or family member will be joining from a different location, so that any necessary technology-related information can be shared.

Gather your medical information, including information about your diagnosis, treatment plans, surgical procedures, any other health conditions you have and your family medical history. Create a list of your prescriptions plus any over-the-counter products or supplements that you are taking. It is also helpful to have your insurance information handy.

When scheduling your appointment, ask if there are any vital signs you should measure on the day of the visit (e.g., temperature, blood pressure). If you are able to, have the measurements ready to share.

Appointment Day

The day of the appointment:

• Dress in loose, comfortable clothing.
• Find a space that is quiet, private and well-lighted.
• Check your internet connection.
• Plug in your device or make sure it is fully charged.
• Check that your microphone and camera are working.
• Make sure any required program or application is properly downloaded.
• Ask others in your household to avoid streaming video during your appointment, as this can slow your internet connection.
• Close any other programs or applications to maximize the quality of the connection and to reduce distractions.
• If you are using a smartphone or tablet, prop it up on your desk or table so that the camera is steady and facing you.

Once the appointment starts, try not to be too close to the camera. Your head and shoulders should be visible, similar to a driver’s license or passport photo.

Taking your medication on schedule is known as adherence. Adherence is key to getting the best possible result from your treatment and is a topic that is often emphasized in telemedicine appointments.

Medicines that treat cancer that are taken by mouth come in different forms—pills, tablets and capsules. The term “oral medication” is used throughout this section in referring to this type of medicine.

To keep a steady amount of medicine in your body, oral medications release the “active ingredient” (the part of any drug that produces the intended effect) over a set period of time. If a dose is skipped, the level of medicine is lowered, which can reduce its effectiveness. Doses that are taken too close together may result in too much medicine being in your body, leading to an increase in the risk or severity of side effects.

The schedules for taking your oral medication are set by your doctor, based on the type of medicine and your individual circumstances. Some are taken multiple times each day. Others are taken once daily, or a few times a week. Oral medication can also be prescribed for a period of time that includes a break of a number of weeks.

Questions to Ask When Starting a New Medicine

Asking questions at the time you are prescribed a new medicine will help you get the most from your treatment. It can also help open the lines of communication with your health care team.

Following are a few questions that you can ask. There are likely others, based on your specific situation. Ask your doctor to share any other guidance they may have. Make a note of your doctor’s answers and advice in your journal or on a tablet or smartphone (see “Communicating With Your Health Care Team”).

How does this medication work? As an educated consumer, having a basic understanding of the medication’s “mechanism of action” (the way it works) is good information to have. This knowledge may also contribute to your maintaining a high level of adherence.

How should I take this medication? Some medications should be taken with food, while others work better if taken on an empty stomach. Some may need to be taken with a certain amount of liquid, or they may be most effective if taken at a specific time of day.

What are the possible side effects of this medicine? All cancer treatments can cause side effects. Ask your doctor or health care team about the possible side effects you may experience, and their potential seriousness.

What should I do if I miss a dose? Even with all of your best efforts, you may occasionally forget to take your medication on time. At the time your medicine is prescribed, ask your doctor what you should do if this happens.

Can I still take my other medicine? Make sure your doctor has a list of all of the medication you are taking, including over-the-counter medication, vitamins and supplements. They may recommend a change or adjustment. Your doctor can also provide guidance on how to “space” your medication throughout the day.

Should I change my diet? Ask if there are any specific foods, drinks or spices that you should avoid or limit while taking your medication. Also ask if there is any particular type of diet plan that would be beneficial for you to follow.

After your initial discussion with your doctor, be sure to contact a member of your health care team if anything is unclear or if you need additional information.

Tips to Help You Take Your Medication on Schedule

Your doctor and other members of your health care team understand that you may face obstacles that affect your ability to adhere to your medication schedule. With their guidance and the following tips, you should be able to stay on schedule with your medication.

• Ask your doctor if it’s appropriate for you to be prescribed a 60- or 90-day supply, which minimizes the risk of your running out of medication.

• Set an alarm on your watch, smartphone or computer to remind you when it’s time to take your medication. You could also try a medication reminder app. There are a number of free and highly-rated apps that can be easily found by a quick internet search. (A low-tech approach could be as simple as keeping a running list of the date and time each dose was taken.)

• Note the date you will need to refill your prescription (a few days before you run out) and put a reminder wherever you are sure to see it.

• When you pick up a new supply of medication, check the label for the number of refills that remain on your prescription. If there are zero refills, call your doctor’s office to renew your prescription (or ask your pharmacy to do that for you).

• Sign up for any reminder services that your pharmacy offers. Many pharmacies will send you text messages and/or place automated calls when a refill or renewal is due.

• Consider using your insurance carrier’s mail service pharmacy. You can receive convenient home delivery if your specific medication is part of this service, often in supply amounts larger than 30 days.

All cancer treatments can cause side effects. It’s important that you report any side effects you experience to your health care team so they can help you manage them. Report them right away—don’t wait for your next in-person or telemedicine appointment. Early reporting can help improve your quality of life and allow you to stick with your treatment plan.

This section provides tips and guidance on how to manage certain common side effects should they occur.

Managing Digestive Tract Symptoms

Nausea and vomiting

• Avoid food with strong odors.
• Avoid overly sweet, greasy, fried or highly seasoned food.
• Nibble on dry crackers or toast. These bland foods are easy on the stomach.
• Having something in your stomach when you take medication may help ease nausea.

Diarrhea

• Drink plenty of water. Ask your doctor about using drinks (such as Gatorade©) which provide electrolytes. Electrolytes are body salts that must stay in balance for cells to work properly.
• Over-the-counter medicines such as loperamide (Imodium A-D© and others) and prescription drugs are available for diarrhea but should be used only if necessary. If the diarrhea is bad enough that you need medicine, discuss it with your doctor or nurse.
• Choose fiber-dense foods such as whole grains, fruits and vegetables, all of which help form stools.
• Avoid food high in refined sugar and those sweetened with sugar alcohols such as sorbitol and mannitol.

Loss of appetite

• Eating small meals throughout the day is an easy way to take in more protein and calories, which will help maintain your weight. Try to include protein in every meal.
• To keep from feeling full early, avoid liquids with meals or take only small sips (unless you need liquids to help swallow). Drink most of your liquids between meals.
• Keep high-calorie, high-protein snacks on hand such as hard-boiled eggs, peanut butter, cheese, ice cream, granola bars, liquid nutritional supplements, puddings, nuts, canned tuna or trail mix.
• If you are struggling to maintain your appetite, talk to your health care team about whether appetite-building medication could be right for you.

Constipation

• As hydration is important, make sure to drink plenty of fluids. Also, limit your intake of caffeine and alcoholic beverages, as they can cause dehydration.
• Include foods high in fiber in your daily diet, such as fruit (especially pears and prunes), vegetables and cereals. If your health care team approves, you may want to add synthetic fiber to your diet, such as Metamucil©, Citrucel© or FiberCon©.
• Be as physically active as you can, after checking with your doctor on the level of physical activity that is right for you.
• If your doctor has prescribed a “bowel regimen,” make sure to follow it exactly.

Managing Fatigue

Fatigue (extreme tiredness not helped by sleep) can be due to cancer’s effect on the body and is one of the most common side effects of many cancer treatments. If you are taking oral or intravenous medication, your doctor may lower the dose of the drug, as long as it does not make the treatment less effective. If you are experiencing fatigue, talk to your doctor about whether adjusting the dose is right for you.

There are a number of other tips for reducing fatigue:

• Take several short naps or breaks during the day.
• Take short walks or do some light exercise, if possible.
• Try easier or shorter versions of the activities you enjoy.
• Ask your family or friends to help you with tasks you find difficult or tiring.
• Save your energy for things you find most important.

Fatigue can be a symptom of other illnesses, such as diabetes, thyroid problems, heart disease, rheumatoid arthritis and depression. Fatigue may also be a sign that your nutritional intake has been too limited by cancer or its treatment. Be sure to ask your doctor if they think any of these may be contributing to your fatigue. A visit with an oncology nutritionist or a physical or occupational therapist who is knowledgeable about cancer can be of tremendous help. Your health care team should be able to provide a recommendation.

Managing Pain

There are a number of options for pain relief, including prescription and over-the-counter medications. It’s important to talk to a member of your health care team before taking any over-the-counter medication to determine if it is safe and will not interfere with your treatment. Many pain medications can lead to constipation. Your doctor can recommend over-the-counter or prescription medications that help to avoid or manage constipation.

Physical therapy, acupuncture, progressive muscle relaxation exercises and massage may also be of help in managing your pain. Consult with a member of your health care team before beginning any of these activities.

Q: How is my privacy protected if I participate in telemedicine sessions?

A: Health care providers are required to keep certain information private and secure, whether these are physical files kept in their office or digital information shared over the internet and stored electronically. Because of these requirements, your health care team may be limited to different video conference programs than those you might use to chat with family or friends. Contact your treating health care team with any questions about the security of your information.

Q: My doctor emphasizes the importance of medication adherence in my telemedicine sessions. Is a pill sorter a good idea?

A: Many people use a pill sorter (available for purchase at drug stores and online) to sort all or some of the pills they take. Before doing so, ask a member of your health care team if there is any concern with your cancer medication being taken out of its original bottle or packaging. Also ask if it poses any problems for your cancer medication to be stored in the same pill sorter as your other pills.

Q: In one of my telemedicine sessions, my doctor mentioned quality of life clinical trials. What are they?

A: Quality of life trials do not evaluate treatments whose main purpose is to control cancer; rather, they address such issues as short and long-term effects of therapy, prevention of pain and issues related to nutrition, changes in your activity level or stress. These types of trials are often available to people being treated for cancer.

Q: What is a treatment summary and why is important?

A: There are two types of treatment summaries: those you create yourself and those given to you by your surgical, medical or radiation oncologist when you complete treatment. Keeping your own records up-to-date in the form of a treatment summary can be helpful, as it allows you and your family members to have instant access to the specifics of your cancer diagnosis and treatment. A treatment summary should include:

• Your name and date of birth
• Date of diagnosis
• Prescribed therapy/therapies, including dates started and stopped and dosages when appropriate
• Dates and types of baseline and post-diagnosis testing and the results of these tests
• Other medications and supplements you are taking
• Blood transfusion dates and results
• Names, affiliations and contact information of all members of your health care team

Ask the members of your health care team what they suggest be included. Take your personal record with you when you visit any doctor—not just your oncologist—and have it handy during telemedicine appointments.

Many cancer treatment centers provide a care plan summary (sometimes called a survivorship care plan) as a record of the care you received. This is for your records and for you to share with other members of your health care team, particularly your primary care doctor. This summary is important for your follow-up care, especially if your cancer treatment team and your primary care doctor do not use the same electronic health record system.