Zisis Kozlakidis from the International Agency for Research on Cancer and Symeon Psomiadis from the University of Athens, Greece lift the lid on digital health and cancer, including how remote care is being supported during COVID-19
The improvement of quality in healthcare represents a vital objective for healthcare systems globally. Every patient has a right to receive timely, safe and effective care; be informed about the care process in an appropriate manner; and be informed about the relative risks and benefits of any treatment decisions. In 2012, all governments, members of the World Health Organization (WHO) approved the Global Monitoring Framework on Non-communicable Diseases (NCDs), which includes a commitment to reduce premature NCD (including cancer-related) deaths by 25% by 2025. This target was reiterated in 2017 in the World Health Assembly as part of an integrated approach. (1) While the timing of achieving such targets might need to be reconsidered in light of the coronavirus pandemic emergency, it demonstrates a clear commitment towards the improvement of quality in healthcare and cancer being a central component of these actions.
The growing burden of cancer constitutes a major public health threat which no healthcare system seems sufficiently prepared to tackle it alone because of its scale and complexity. Cancer is a life-threatening disease that should be treated in a timely fashion to avoid a detrimental outcome to patients and minimise their physical and emotional suffering, often requiring co-operation between different teams of professionals. Without careful planning by healthcare providers, national governments and international organisations, there is a risk that the rising number of cancer cases will overwhelm healthcare systems, compromising the quality of care available and crowding out the investments required to better prevent and treat the disease. The adoption of innovative approaches, in particular, of digital-based approaches, is viewed as one of the ways in which healthcare systems will be better able to prepare and address these future pressures while improving the quality of delivered services. Here, we present some of the key sectors where digital health is most likely to impact on cancer healthcare in the near future.
COVID-19: Digital health supporting remote care
Remote care or telehealth services have already been used to a small extent in routine care as well as emergencies. During the COVID-19 pandemic, their wider utilisation has accelerated and remote care services are now adopted for large-scale screening of patients prior to their visit and triage assessment, in the routine follow-up and/or monitoring of patients at home, for remote clinical encounters, or supervising patient care by off-site experts (2). It is likely that a significant portion of such services will remain telehealth-based post-COVID-19, such as the remote monitoring and management of greater numbers of patients post-operatively, as it provides higher convenience and better patient-centred care, therefore, partially addressing the anticipated healthcare system flow rate and capacity pressures. Thus, a future “blended approach” is likely to emerge, where remote health solutions occupy a greater part of routine services. Additionally, the currently developed expertise, because of the pandemic, can be used in expanding a wider public health approach; perhaps utilising not only guided (by clinicians) but also fully patient/self-guided interventions, such as self-help apps or online therapeutic modules.
Digital health and cancer diagnosis
The earlier detection of cancer is often directly correlated to a more personalised and, therefore, a more successful treatment outcome. The current emphasis on the development of digitally enabled and where possible, minimally invasive assays enabling early diagnosis, may provide a solution to the increasing demands on the healthcare system, as well as a promising alternative to some tumour biopsy methods. This approach is underpinned by what is collectively called as digital pathology. Although digital pathology dates back as an idea to the early 1960s, it wasn’t until the 1990s that rapid advancements in radiological developments for cancer were able to be achieved through mass-research and analysis of clinical data, facilitated by this ‘early form’ of digital health. The subsequent technological growth in operational flexibility and capacity, in image scanning and computer storage, along with more powerful and affordable technology (in the 2000s) created the right conditions for the rapid development of digital pathology. (3)
Specifically, recent technological advances have allowed the secure sharing of digital data over larger distances, the comparison of large data sets, as well as access to past case studies from either the same patient or similar cases for assessment and research. As a result, the comparison of multiple cases can be facilitated and processed much faster than ever before, while maintaining the quality of healthcare service. It is not only the speed of delivery that is important, crucially the quality of digital pathology and computer-aided diagnostic techniques enable the integration of knowledge into the clinical workflow. (4) Additionally, digital pathology data are also becoming available to researchers through secure platforms, who are now able to conduct their work and annotate their findings with greater speed and, with the help of artificial intelligence (AI), perhaps with greater efficiency than before.
Digital health and community-based approaches
Health-related online social networks are starting to play a role in many people’s daily lives by enabling them to monitor their behaviour and motivating them to change their lifestyles in relation to existing conditions. Such platforms provide the opportunity to interact, engage, and share. However, while the social interaction component has been studied extensively, the interaction with routine health services is less well described, and the potential opportunities remained largely unexplored. (5) The technology supporting digital health has the capacity to democratise access to healthcare services and span over socio-economic divides. For example, skin conditions could be monitored remotely through the individual taking sequential photos of the same part of the body for monitoring purposes, using AI-based apps. Such images can be produced in resource-restricted settings and analysed digitally by experts in specialised centres. However, more work is required to achieve this in an effective and sustainable manner, and to be able to address the follow-up demands it might create to the healthcare service.
The realisation that digital health solutions can be implemented and work well should constitute the benchmark for the greater integration of such technologies as part of routine healthcare design and provision. Optimal outcomes can be attained where both patients and healthcare providers become active participants in this process. The scale of the global cancer challenge necessitates that healthcare adapts to the rapid pace of technological change in pursuing effective research and operational solutions that benefit patients with cancer worldwide.
Where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization (IARC/WHO), the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer/WHO.
- World Health Assembly, 70. (2017). Cancer prevention and control in the context of an integrated approach. World Health Organization (WHO). https://apps.who.int/iris/handle/10665/275676
- Jazieh AR and Kozlakidis Z (2020) Healthcare Transformation in the Post-Coronavirus Pandemic Era. Front. Med. 7:429. doi: 10.3389/fmed.2020.00429.
- Madabhushi, A., & Lee, G. (2016). Image analysis and machine learning in digital pathology: Challenges and opportunities. Med Image Anal; 33:170-5.
- Niazi, M. K. K., Parwani, A. V., & Gurcan, M. N. (2019). Digital pathology and artificial intelligence. The lancet oncology, 20(5), e253-e261.
- Abusanad A (2020). ‘‘Najia’’ Story: A WhatsApp Support Group For Patients With Breast Cancer. 1(1). DOI: 10.36401/IDDB-20-01.
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