Telehealth and Teletrials

While telehealth has existed in Australia for some time, it’s entirely possible many patients and caregivers hadn’t heard about it until the COVID-19 outbreak when the government announced a new telehealth program as part of its response to ‘flatten the curve’.

Rural communities have had access to telehealth for a while – but when COVID-19 led to increased social distancing and isolation measures, there was a need to expand the offering. Telehealth allows people to access essential health services in their home when they are unable to visit face to face.

In addition, telehealth is a way of delivering health services remotely, either through telephone, video conferencing or other forms of communication technologies. It allows health services to be brought to patients who are unable to be in physical contact with a health service provider and the consultation can be done on various platforms such as FaceTime,  phone, Zoom and Skype.

Teletrials builds on the telehealth model and increases access to clinical trials for people with cancer living in rural and remote locations. Teletrials also allows trial recruitment and activity to continue and expand.

ANZUP’s first teletrial was under the guidance of Dr Craig Underhill of Border Medical Oncology in Albury. The UNICAB trial is now also  conducted as a tele-trial and will increase the pool of patients who will be able to participate. UNICAB is a phase II trial aiming to find how safe, tolerable and effective a new treatment called Cabozantinib is for non-clear cell kidney cancer.

Dr Craig Underhill said, “Regional cancer patients experience several disadvantages including lower survival rates, due to healthcare access differentials…..a Teletrials Program aims to reduce the barriers for regional patients with cancer to access clinical trials, including travel, cost and social disruption.”

Our DASL-HiCaP trial, a randomised phase 3 study, aiming to demonstrate that the addition of the new potent oral hormonal therapy, darolutamide, to the standard radiation therapy and testosterone suppression improves the outcomes of people with localised high-risk prostate cancer, is also a teletrial.

What is a teletrial?

teletrial allows a clinician at a larger centre (primary site) to enrol, consent and treat patients on clinical trials in collaboration with smaller regional and rural centres (satellite sites), allowing patients to participate closer to home.

Participation in clinical trials is recommended as the best option for many cancer patients. The teletrial model means access to novel, ground-breaking treatments for everyone no matter where they are based – in isolation, regional, rural and remote areas. This model has the potential to connect larger centres, even within the same city, and improve the rate of recruitment to highly specialised clinical trials.

Medical oncologists and trial coordinators from primary trial sites can use teleoncology to help obtain consent, recruit, treat and monitor patients at satellite sites, and at home, during routine or trial‐specific consultations depending on the type of study. And just as with face-to-face clinical trials, teletrials also takes into consideration the requirements for proper conduct to ensure the trials are both safe and ethical.

 Will telehealth and teletrials continue to grow?

Telehealth has already expanded in response to the coronavirus crisis so it is sure to become more widely accepted and even easier to use in the future. There is no reason why telehealth tools won’t become an integral part of healthcare systems worldwide and digital health is a quickly developing tool for regional patients’ access to health services. ANZUP hopes the success of the UNICAB teletrial will help the health service challenge of meeting recruitment targets and bring cancer treatments and trial participation to the broader community.