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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