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Rapid expansion of telemedicine is one of the transformative healthcare consequences of the COVID pandemic. As a result, telemedicine has allowed clinicians to address the needs of older adults with cancer, who faced the highest risks from COVID, while maintaining safety at home. In light of the COVID experience, which is an important source of learning, this article provides guidance on approaches to enhance telemedicine-enabled supportive care for the geriatric cancer patient.

272 Background: MSK is deploying teleoncology solutions that improve the patient experience, quality of care, and enhance patient access. MSK’s teleoncology mission is to utilize digital technology as a mainstream channel for connected care across the cancer continuum. Methods: Teleoncology programs were established between Manhattan and four regional sites in support of Psychiatry, Genetic Counseling, and Supportive Care. MSK’s “Virtual Programs” delivered tele-education and tele-support to patients and caregivers in their home or place of work to prepare them for each stage of their care. Patient acceptability ratings were evaluated for quality of care, ease of use, interaction quality, and satisfaction and future use. Results: The four programs generated 7563 teleoncology visits. Virtual Programs served 3865 patients over 766 sessions. Fifty-eight percent (N = 2269) of patients participated in group education sessions (8.3±1.2 patients per session), while 41.3% (N = 1596) participated in support groups (3.2±0.3 patients per session). Overall, 60% of Virtual Program sessions were delivered to patients at home, and 20% to patients at work. Tele-genetics counseling was provided to 3516 patients. The majority of tele-genetics sessions occurred at regional sites (61.4%). Thirty-eight patients completed 159 telepsychiatry visits (4.2±5.8 visits/patient). In Supportive Care, 23 patients completed 38 visits (1.6±1.4 visits/patient). Patients saved 95 minutes of travel time per teleoncology visit. Acceptability ratings for teleoncology were collected from 1185 patients (15.7%). Ninety-one percent of patients were satisfied or extremely satisfied with their teleoncology experience, 95.6% with the information they received, 94.4% with the skill of the provider, and 86.3% with the ease of use of the teleoncology platform. Conclusions: Teleoncology offers an innovative means of providing cancer care to patients by decreasing the stress of travel, missed work, and caregiver requirements. Patients reported that teleoncology made care more accessible and allowed them to remain in their community with family support. For clinicians, teleoncology expanded patient outreach, and improved patient adherence.

99 Background: Inpatient palliative care (PC) teams have increased their presence over the past decade, with over 90% of hospitals having access to PC specialists. However, such growth has not been mirrored in the outpatient setting; this is relevant for patients living far from major medical centers. Memorial Sloan Kettering Cancer Center (MSK) has expanded its ambulatory care footprint beyond New York City (NYC) to sites where PC is not currently available. To address the need for PC delivery to a geographically dispersed patient population, we developed a clinical initiative utilizing telemedicine technology. Methods: The Telemedicine Palliative Care Program (TPCP) was initiated after planning with multiple stakeholders, including clinical, legal, billing, compliance, ambulatory care, information systems, and scheduling departments. The TPCP provides PC consultation and management of patients via a “hub-and-spoke” model, whereby PC specialists are located at the main campus in NYC and patients are scheduled to be seen at one of six regional ambulatory cancer sites within a 50-mile radius. Regional ambulatory sites have video teleconference rooms equipped with Cisco (San Jose, CA) TelePresence MX300 hardware and Jabber software allowing for secure, high fidelity, real-time video communication with clinicians at the main campus who use iPads installed with Jabber software during their consultation sessions. Results: The TPCP is currently active at two regional sites in New York and New Jersey. Patient satisfaction, perception of quality of care, and patient outcomes will be measured. Preliminary results indicate that both patients and providers find this clinical program to be an extremely valuable experience. Conclusions: The technologic infrastructure is now available to deliver telemedicine-enabled PC for cancer patients in a geographically distributed model. Our early experience suggests that our program will help enable the convenient delivery of concurrent PC to cancer patients across a wide geographic area. This innovative clinical initiative has the potential to enable all MSK patients to access high-quality palliative care in a geography-agnostic manner, and eventually deliver such care to patients in their homes.

This chapter is organized into two main sections. The first section provides an overview of special concerns of older patients at the end of life. The second section focuses on the assessment and management of common symptoms experienced by this population at the end of life.