Discussion:
This case illustrates the limitations of remote video consultations for
cancer during the COVID-19 pandemic, although telemedicine attracts wide
attention with enthusiastic endorsement by the Japanese government and
the information technology industry. Without finding a nearby
collaborating hospitals that can provide necessary examinations and
treatments when they are required, telemedicine should not be
thoughtlessly indicated as a major medical provision strategy especially
for patients with metastatic cancer or progressive
diseases.6
In general, post-operative surveillance for early-stage breast cancer
patients include annual mammography and other adjunctive medical
examinations, such as ultrasonography and CT. 7 On the
other hand, for breast cancer patients with metastasis or recurrence,
serum tumor marker tests and other imaging tests are recommended every
few months, depending on patients’ conditions.8
In our case, the university doctor in charge understood the importance
of performing a CT immediately considering the patient’s condition, and
she also made an effort to find a nearby hospital. However, it
eventually took seven months until she could visit our hospital,
probably due to the nationwide confusion of medical institutions brought
by the pandemic and scarcity of specialty physicians and hospitals in
rural areas like Fukushima. While the importance of collaborations
between medical institutions have been well understood both in general
and medical communities, the current COVID-19 pandemic has been
reiterating its importance since it has become increasingly difficult to
find a referring hospital now that lots of hospitals are overburdened by
the COVID-19 pandemic and or restricts acceptance of new patients as its
countermeasures. If the patient or the doctor could have found a medical
institution much earlier, her metastasis might have been detected at a
smaller stage.
Considering that the COVID-19 pandemic is occurring intermittently in
Japan, it is necessary not only to rely on the introduction of novel
telemedicine technology but also to reform and adjust the traditional
referral system for medical institutions suitable for the post-pandemic
era, especially between urban and rural areas. Telemedicine can be a
useful option, but simultaneously, patients who have been receiving
treatment at hospitals in urban areas should be able to continue their
treatment in rural areas even when it becomes difficult for them to
visit hospitals in urban areas.9
Therefore, it is important for medical institutions to take this
opportunity to recognize the advantages and disadvantages of
telemedicine. In general, a remote video consultation is an effective
method such as for patients with skin diseases that can be detected
visually, or to control a patient’s blood pressure.10However, as in this case, the indication of telemedicine for patients
requiring specialized diagnostic imaging on a regular basis is still
limited, and it is important to understand its limitations before
selecting suitable patients.
In conclusion, this case report demonstrates that telemedicine cannot
fully complement medical care for patients with breast cancer metastasis
due to limited access to the medical institutions during the COVID-19
pandemic. In order to provide telemedicine effectively, it is very
important to encourage both patients and medical professionals to
collaborate with other medical institutions, for securing referral
hospitals and providing highly specialized treatments.
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