PHYSICAL EXAM IN MEDICAL ONCOLOGY: DEVELOPMENT OF A PROTOCOL FOR TELEMEDICINE CARE IN A PUBLIC HEALTHCARE ONCOLOGY SERVICE

Introduction: The COVID-19 pandemic led to a rapid regulation and structuring of remote working for various activities in society, including medical care. Cancer patients have a greater predisposition to infections and a greater risk of unfavorable outcomes. In addition, several studies have demonstrated cost-saving with remote care. In the other hand, there is a concern regarding telemedicine in oncology considering the severity of the disease. Objectives: The primary objective of this study is to evaluate the role of Physical Exam (PE) as the main factor for change in the cancer treatment and relate PE abnormalities with tumor primary site, staging and symptomatology. Methods: This is an observational and prospective study, conducted at two Brazilian public healthcare oncology centers. A multiple-choice form, developed by the researchers, was filled in to collect patients’ clinical variables, symptoms, PE abnormalities, and oncological treatment determined at the end of the consultation. Results: The authors included reports from 368 clinical appointments from August/2021 to December/2021. The most common neoplasms were breast, colorectal, and prostate cancer. 41% of patients were symptomatic at clinical appointment. The PE was normal or with abnormalities already seen in previous consultations in 87% of the cases. Among 49 patients with a new And in the PE, the oncological treatment was maintained in 59%, complementary exams and specialists appointments were requested for 31%, and 10% of the cases had the oncological therapy modified directly after the PE. Statistical analysis showed a significant association between the altered PE and the following variables: primary site breast (n=27; 21%; p<0.01), head and neck (n=7; 26%; p<0, 01) and ovary (n=2; 17%; p<0.01), presence of symptoms (n=31; 21%; p<0.01), and treatment with palliative intent (n=23;19%; p<0.01). However, only the presence of symptoms showed a positive association with the altered PE and consequent treatment change (p<0.01). Conclusion: telemedicine seems to be a safe modality in the vast majority of cases, given the large percentage of asymptomatic patients with no changes in the PE during face-to-face care. Regarding symptomatic patients, we suggest priority to in-person care. Presential care is also recommended to patients with EC IV tumors undergoing palliative treatment, specially with breast, head and neck, and ovarian cancer. Telemedicine might be safe to curative patients.