Implementation of a Telechemotherapy Module in the Peruvian Jungle with Adequate Quality of Life: Breaking the Access Gaps to Health with Teleoncology

Abstract

Background: Cancer is a leading cause of death worldwide as well as in Peru. The national cancer plan includes decentralization, but one of the greatest barriers is our complicated geography. San Martin is a department located in the Peruvian jungle where there are no public services for cancer care. Our aim was to implement a “distance telemedicine-enabled” outpatient chemotherapy module, monitored by oncologists. Methods: The implementation was conducted in 3 stages: 1) Planning and Organization: working teams were formed, a chemotherapy room was developed and people were trained. 2) Execution: patients from San Martín region, age d >18 years with pathological confirmation of cancer, requiring systemic chemotherapy, ECOG <3, and first course of chemotherapy received at INEN without adverse reaction were selected. 3) Evaluation: adverse events, cost-user evaluation and quality of life (QoL) were assessed. Results: By November 2015, a module with a chemotherapy room with 18 chairs, a pharmacy, a hospitalization room, 1 medical office, a training room, a nutrition area, and a nursing station was implemented. 3 physicians, 3 nurses and 1 pharmacist were trained. Through March 2018, 501 sessions of teleoncology were completed to deliver 232 cycles of chemotherapy for 56 patients aged 19 - 78 years with different solid tumors, with no serious adverse event, without negatively affecting their QoL, and with an average out-of-pocket expense saving of 500 PEN. Conclusions: Using information and communication technology, a telechemotherapy module was successfully implemented in the Peruvian jungle, without adversely affecting the QoL of patients. Neither patients nor family members needed to travel to Lima to receive chemotherapy. This first program can be replicated in other rural and remote regions through non - specialized personnel and facilities, providing chemotherapy services equivalent to a tertiary center through trained health care professionals, supported through telemedicine.