Breast cancer is a complicated condition that often requires care from several different providers. Telehealth services can help save time and allow you to receive some of your care at home. Telehealth services include virtual appointments, patient portal communications, and online education. These services are becoming more common in breast cancer care, especially in light of the need to socially distance due to COVID-19.1
Due to the COVID-19 pandemic, doctors’ offices are taking special precautions to allow for safe in-person care. Some examples include spacing out waiting room chairs, providing masks, minimizing patient wait times, and offering hand sanitizer. Getting your care from home can reduce your risk of being exposed to the coronavirus, and cut down on unnecessary trips and appointments. However, it’s important to remember that some aspects of care require an in-person visit with your cancer care team.
When to Use Telehealth for Breast Cancer
Telehealth services are becoming more common in the management and treatment of breast cancer, and there are many different types of appointments that can be conducted from home. Whether you’re seeking a second opinion or have questions about a medication’s side effects, telehealth may be able to help.
To Prepare for an In-Person Visit
Telehealth services can be beneficial even if you do decide to see your doctor in their office. You can cut down on your wait time by completing check-in paperwork ahead of time from home and submitting your insurance information and any changes to your medication schedule. Your healthcare provider may also be able to evaluate your condition through remote patient monitoring devices that collect biometric data before your appointment.2
After an Abnormal Mammogram
Telehealth services may be appropriate for your initial consultation with an oncologist following an abnormal mammogram. If your cancer is nonpalpable, meaning you can’t feel a lump in your breast, you may not have to be seen by a doctor in person, even for your first appointment. Your specialist will review your mammogram findings virtually and speak with you via video chat about your diagnosis and treatment plan. If you can feel a lump, however, make sure your first visit is in the office so your oncologist can evaluate it.
Regular Follow-Up Visits
Once your medical team has evaluated you in person, you may be eligible for conducting your follow-up visits over the phone or video chat.3
Telehealth visits may be appropriate for regular follow-up appointments meant to serve as a check-in and for answering any questions you have about treatment.
During a follow-up visit for breast cancer, your doctor will review any recent lab tests or scans with you, as well as recommend treatment changes if needed. These types of appointments are also an opportunity for you and your loved ones to ask questions and alert the medical team to any changes in your condition. Your oncologist will help you determine how often to come into the office and when those appointments can be done virtually.
A telehealth visit may be possible if your breast cancer surgery was uncomplicated and you are not experiencing any issues with wound healing or infections. Be prepared to show your doctor your surgical incisions using your device’s camera during the appointment.
For New Symptoms or Side Effects
As you begin your treatment plan for breast cancer, you may experience new symptoms such as pain or fatigue. The treatments may cause side effects like headaches, nausea, or diarrhea. Telehealth services allow you to contact your medical team and adjust the treatment plan as needed.
If you are experiencing serious side effects from your treatment, it’s best to see your oncology team in person. Effects that require an in-office evaluation include uncontrolled vomiting and diarrhea since these symptoms could lead to dehydration, uncontrolled bleeding, confusion, change in vision, and chest pain.
Side effects of treatment that can be safely managed using telehealth include:4
- Hair changes
- Menopause symptoms
- Mouth sores
- Nail changes
- Changes in taste or smell
- Vaginal dryness
To Enroll in a Cancer Clinical Trial
If you decide to enroll in a cancer clinical trial as part of your treatment plan, much of the enrollment process can be done virtually. A research nurse will discuss the trial with you and provide information on consent, participation, and follow-up monitoring. A physical exam may be recommended as well.
To Seek a Second Opinion
If you have decided to seek a second opinion on your breast cancer diagnosis, telehealth may be helpful. Your new oncologist will be able to review your chart and all of your findings ahead of time, then talk with you virtually about their opinions on your care. If you decide to transfer your care to a new oncologist, your new doctor will most likely recommend an in-person visit after your initial virtual meeting.
For Multidisciplinary Care Appointments
During your breast cancer treatment, you will most likely receive care from several providers, including an oncologist, nurse practitioner, oncology surgeon, plastic surgeon, physical therapist, occupational therapist, and psychologist, to name a few. Telehealth appointments make it possible for several team members to attend the same visit and make better decisions together.
Not all health needs can be addressed on a virtual call. For example, a doctor cannot provide a breast cancer diagnosis without physically examining you. Your physician may also need to see you in person if:5
- You feel a new lump in your breast
- You develop a high fever
- Your physician recommends a physical exam or routine breast exam
- You need blood work or another lab test
- Your treatment requires in-person care, such as radiation therapy
- Your surgical incisions are red, painful, or oozing discharge
- Your treatment side effects are severe enough to need emergency treatment
- You do not have access to reliable technology or internet services
Benefits and Challenges
Using telehealth for patients with breast cancer is still a new practice, and there are several benefits, as well as a few challenges.
Time and Cost Savings
In general, telehealth is more convenient for patients, especially those trying to squeeze medical appointments into their hectic work schedules. If you have recently had surgery and are not having any issues, seeing your doctor virtually is likely much easier, especially if you are still experiencing postoperative pain.6
Telehealth also tends to be less expensive. It cuts down on other expenses like gas for the car, Uber or Lyft fees, bus fare, or parking fees at the hospital as well.
A 2020 study found that patients undergoing care for breast or other gynecologic cancers reported that telehealth services saved them time, increased their access to care and improved their health overall.7 The survey also found that respondents felt that access to telehealth made them feel more actively involved in their care and allowed their family members to be more involved in their treatment plan as well. A telehealth appointment may allow more of your family members or caregivers to understand your treatment plan and provide updates to your healthcare team.
Better Quality of Life
Studies have found that telehealth for breast cancer is associated with less stress and a better quality of life for patients and their families.7 Engaging in telehealth services may also help patients feel more independent during their care. This is especially helpful when being treated for cancer since so much of what is happening to them is outside of their control.
While there are many positives, there can be drawbacks to telehealth as well. Telehealth software can be challenging for even the most tech-savvy patient to navigate, and the call may cut out or fail during the appointment. This is frustrating for both the patient and the provider. It’s helpful to have a plan in place, such as a direct number to call if a virtual appointment fails or backup devices.
Studies have found that a small number of patients found virtual visits to be either emotionally or physically uncomfortable, and others worried about their privacy while using the computer.7
No major safety concerns with using telehealth for breast cancer management have been reported, but it’s important to remember that technology cannot replace a physical exam. If you are concerned about a new physical finding or have been experiencing new and severe symptoms, an in-person visit is most likely the best choice.
Any new signs or symptoms that could warrant a trip to the emergency room, such as high fever, mental confusion, chest pain, or bleeding are not appropriate for telehealth visits.
How to Prepare for a Telehealth Visit for Breast Cancer
To find a telehealth provider, start by asking your oncologist if they offer virtual visits. Your medical team will also have suggestions for telehealth resources. When scheduling the appointment, ask if the appointment will be over the phone or video chat. Then find out if you’ll be seeing your physician or another member of the team.
Once you have an appointment, call your insurance company to confirm that the visit will be covered. Your doctor’s billing department knows which telehealth visits are usually covered, so ask them ahead of time.
On the day of your appointment:
- Find a quiet place in your home where you’ll be able to talk with your provider without interruptions. If you are using a public computer, bring headphones.
- Install any needed software and test out the camera and microphone on your device before your appointment. Ask a relative or friend for help if you’re having trouble getting it set up.
- Make sure your device is charged and that you have the phone number for the clinic in case you are disconnected.
- Think through the questions you’d like to ask and any updates for your team. Preparing and keeping written notes with you may help.
- If you have recently had breast cancer surgery, be prepared to show your incisions so that your doctor can evaluate your healing. Find a private place for your call, and opt for a loose, stretchy shirt that will allow you to show your incisions while remaining as covered as possible. Keep a blanket nearby to help with privacy.
- Write notes about any changes to your treatment plan, including medications, chemotherapy schedule, or radiation therapy.
Will Insurance Cover Telehealth for Breast Cancer?
There is not a consistent policy across the country for how telehealth services are covered. It is always best to call your insurance company to find out their specific policies. A good starting place is the National Consortium of Telehealth Resource Center, which offers a database of telehealth billing policies by state. If you don’t have insurance coverage, you may be able to use telehealth services by paying out of pocket. For example, a follow-up visit to discuss hair loss could cost anywhere from $31 to $115 depending on the provider.8
What Happens During the Visit
Once you have logged on for your telehealth visit, the appointment should feel very similar to an in-person experience. You will sit with your physician or healthcare provider to discuss your care. If you would like other family members to be present, ask if others could join the call.
Before starting the visit, you may be asked to acknowledge the fact that you understand the limitations of a telemedicine visit, including the inability to do a full medical exam, possibly missing subtle findings that might have been obvious on a face-to-face visit.
You have the right to refuse to participate in services delivered via telemedicine and ask for an in-person visit.
Appointment with a New Provider
For new consultations, your doctor will take a detailed personal and family history. Be prepared to provide your family history of cancer, especially breast cancer. Your oncologist will ask about your symptoms and how long you have been experiencing them. They will also review your most recent mammogram and any lab findings. They will then take time to provide education about your specific type of breast cancer, your prognosis, and your treatment plan.
During follow-up calls, a member of your medical team will ask about any new symptoms or medication side effects you have been experiencing. They will review recent lab tests or findings with you and explain any necessary changes to your care plan. During this time, your provider may share their screen to show you your lab results or written instructions. Feel free to take screenshots and write notes as they talk.
If your provider recommends starting a new medication during the visit, a prescription will be sent to the pharmacy of your choice. Be sure to ask questions about any new medications, including what it treats, dosage, schedule, and possible side effects.
When concluding your appointment, ask your provider about future appointments and if they will be virtual or in person. If you think of additional questions or concerns after the appointment, reach out to your care team via phone or using the online patient portal.
Providers offering telehealth visits must comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and protect the privacy of your health information during and after the appointment. Healthcare providers may use “any non-public facing remote communication product that is available to communicate with patients.” This means that services like Facebook Live and TikTok are not appropriate (or legal) to use for seeing patients.
A Word From Verywell
Being diagnosed with breast cancer may be the most stressful experience of your life. Telehealth appointments could be a small way to make your care a bit more convenient and take away a little bit of the stress. Using telehealth services allows you to avoid unnecessary trips to the doctor’s office while letting your loved ones participate in the appointment. Receiving care from home also decreases your risk of being exposed to COVID-19. However, if you are experiencing new symptoms like a lump in your breast or a high fever, it’s still best to be evaluated in-person.
Barbara Jacoby is an award winning blogger that has contributed her writings to multiple online publications that have touched readers worldwide.