MORGANTOWN — The COVID-19 pandemic served as a catalyst for many changes in the way physicians interact with their patients, and one of the most prominent has been telemedicine. For patients receiving long-term follow-up care after Gamma Knife treatments, telemedicine has offered an opportunity to bring follow-up visits to patients in the comfort of their homes.
“We actually started this pre-pandemic, so we were able to transition fairly quickly into telemedicine as a routine,” Christopher Cifarelli, M.D., Ph.D., WVU Cancer Institute Gamma Knife program director and neurosurgeon in the WVU Rockefeller Institute Department of Neurosurgery, said. “We had started a program where we were doing on-site telemedicine with patients in the clinic in Elkins at Davis Memorial. We’d have them physically go and sit there in front of an iPad and dial in for patients that were unable to travel to Morgantown. When the pandemic hit, we were well-poised to shift to offering telemedicine appointments so our patients could do them from home.”
Gamma Knife is a form of radiation treatment that targets specific areas of the brain, delivering a highly concentrated dose to the affected area without causing significant damage to the surrounding area. This form of treatment decreases the likelihood of cognitive deficits in patients and can be used to treat vascular malformations and pain syndromes as well.
The treatment is ideal for inoperable tumors but can be used in combination with surgical interventions to increase their effectiveness.
As with all cancer patients, those who receive Gamma Knife treatment require long-term follow-up care. However, that can be difficult for those who must drive a long distance to the WVU Cancer Institute in Morgantown. For these patients, telemedicine saves them time and money while being surrounded by their support system.
“We conducted a study that found that from the second quarter of 2020 to the end of the first quarter of 2021, we had 200 patients with over 300 telemedicine visits who saved a total of 45,000 miles of travel,” Dr. Cifarelli said. “The patients who really took to it were those who required multiple visits in the course of the year, so there was a real savings for them.”
Patients can have their follow-up scans performed at their local hospital and have the data sent to Cifarelli and his team to review before their appointment, further reducing the need to travel for care.
One of the most significant benefits patients have reported is the ability to have their family and loved ones with them during their telemedicine appointments. The pandemic forced hospitals to implement strict visitation policies, so family members found themselves having to wait in the car while the patient saw the doctor. Telemedicine eliminates that factor, allowing the patient to have as many people in the room with them as they feel is necessary.
Glinda Bowman, of Wheeling, was diagnosed with stage four lung cancer in 2015 and learned it had metastasized to her brain when she had a transient ischemic attack (stroke) in 2017. Her surgeons were able to remove one of the two lesions in her brain surgically, and she was referred to the WVU Cancer Institute for Gamma Knife to treat the other. Since then, she has had three more brain lesions treated with Gamma Knife.
“Meeting with Dr. Cifarelli over video conferences is convenient because we don’t have to get up early to travel and leave time for construction or other delays along the way,” Bowman said. “My husband had to drive me to the in-person appointments, so he appreciates the convenience of telemedicine appointments as well. We don’t have to worry about leaving on time and having to stop to eat or get gas. He can sit with me during my appointment and hear everything instead of having to wait outside in the car.”
Being able to hear test results while surrounded by her support system is also important to Wendy Bogers, of Wheeling, who received Gamma Knife treatment after her breast cancer metastasized to her brain in 2017.
“Dr. Cifarelli happened to be on a rotation at Wheeling Hospital when I went to the emergency department because I had a persistent headache with vertigo and nausea,” Bogers said. “He looked at my CT and MRI results and asked if I had a history of breast cancer. They essentially whisked me away by ambulance down to Ruby and had the full work-up done that showed that had it also spread to my liver, lung, brain, and bones. He performed a craniotomy to resect the tumor, then I received a Gamma Knife treatment to make sure the cancer was gone.”
In the five years since the discovery of the original tumor, Bogers has received Gamma Knife treatment for two more small brain tumors. She still has follow-up scans and visits to keep an eye on any changes.
While she enjoys saving the time and gas it takes to travel to appointments in Morgantown, she said she most appreciates being able to receive her test results at home.
“I feel more kind of composed and thoughtful about my questions during telemedicine visits, and I’m able to better center and prepare myself in case it’s not news that I want to hear. I like being in the comfort of my own home and having a list of questions in front of me without going through everything involved with an office visit,” Bogers said.
“If it is bad news, I can kind of process and just curl up on the couch and not have to worry about the drive home and any accidents or road conditions while I’m not fully mentally present to focus on the road. Then, of course, not having to worry about COVID exposure in the hospital and there’s something to be said for being maskless like the old days where you can kind of read faces better and hear them better.”
“The Gamma Knife patients I see are usually in their mid-60s, so they often have trouble driving or driving in inclement conditions and high-traffic areas. For some patients, it can take two hours or more to get here, then they are in appointments and have to drive two hours back. That is a barrier for a lot of patients that presents a significant challenge to consistent long-term follow up,” Cifarelli said.
“Patients are sometimes hesitant to participate because they aren’t comfortable with technology. I ask them, ‘Do you use Facebook?’ and most of the time they say they do. I tell them if you can use Facebook, you can do telemedicine visits. They don’t have to have a computer or an iPad, they can talk to us using a cellphone with a camera. Once patients try telemedicine, very few want to go back to in-person appointments, and even then, it’s usually because they have to be on campus for other visits.”
For more information on the WVU Cancer Institute, visit WVUMedicine.org/Cancer. For more information on the WVU Rockefeller Neuroscience Institute, visit WVUMedicine.org/RNI.