Advancing Cancer Research and Communication with Telemedicine
It eliminates travel, reduces work time and effort, helps manage data, and brings expert care and advice to cancer patients in remote locations. It's TELESYNERGY® - the National Institutes of Health's (NIH) state-of-the-art telemedicine system.
In collaboration with NIH's Center for Information Technology (CIT), NCI researchers have directed their use of TELESYNERGY and its Medical Consultation WorkStations to enhance cancer treatment, research, and communication. Communicating via TELESYNERGY makes meeting management with e-mail and faxes seem like the old days of typewriters and Telexes; it allows many people at different locations to interact as if they were in the same room, viewing and discussing the same medical images in real time. Recently, for example, principal investigators from Bombay and New Delhi, India, met "face to face" in real time with NCI staff in Brussels, Belgium to discuss and establish protocol and data management for an international pediatric cancer trial without the worry and expense of plane tickets, hotel reservations, passports, or lost luggage.
"The TELESYNERGY system is capable of transmitting diagnostic-quality radiology and pathology images; manipulating remote location microscopes and video cameras to examine biopsy samples; and using a patient exam camera that produces high-resolution views of dermatological lesions, skin coloration, and other physical symptoms," said Dr. C. Norman Coleman, Associate Director of NCI's Radiation Research Program in the Division of Cancer Treatment and Diagnosis. "It is also accelerating NCI's efforts to eliminate cancer health disparities."
This ability to simultaneously display high-resolution images in a number of locations has been a major factor in setting up NCI's Cancer Disparities Research Partnership (CDRP) conceptualized by NCI's Dr. Frank Govern who worked closely with Dr. Ken Kempner of CIT in the implementation of TELESYNERGY in the United States and other countries. Currently, TELESYNERGY links experienced institutions involved in NCI-sponsored research to a pilot group of 12 community hospitals with radiation oncology facilities that care for a disproportionate number of medically underserved, low-income, ethnic, and minority populations.
One facility taking advantage of TELESYNERGY is the Cancer Care Institute (CCI) in Rapid City, S.D. CCI serves approximately 100,000 Native Americans from the inner city, the Black Hills area, and 3 surrounding reservations. Through the CDRP program, Dr. Daniel Petereit, a radiation oncologist at CCI, has linked with the University of Wisconsin-Madison and the Mayo Clinic to conduct clinical trials that offer advanced brachytherapy and tomotherapy treatments with implants to Native Americans with cancer. State-of-the-art therapy, shortened treatment time, and reduction or elimination of geographic dislocation from cultural and community roots are just some advantages that result from this partnership. "We use Native American 'patient navigators' to help us understand the barriers and get tribal support for these studies - it took 54 tribal resolutions, but we're up and running," says Dr. Petereit.
Dr. Yadvindera "Bobby" Bains and staff at the Laredo Medical Center in Texas use their newly installed TELESYNERGY system to consult with physicians and researchers in San Antonio, Texas and at NCI on developing suitable clinical trials for their largely underserved Hispanic population. "The project ensures that properly designed and conducted clinical trials will be available to the predominately Hispanic population of Laredo and Webb Counties," said Dr. Bains. Laredo, on the Texas-Mexico border, has no other major U.S. city within a 140-mile range. The TELESYNERGY system eliminates this geographic barrier. Of the city's 95 percent Hispanic population, 35 percent live below the poverty line. The hospital also serves 40 to 60 colonias - unincorporated areas where residents do not have access to running water, electricity, or telephone service and where health care is considered a luxury and not a necessity.
TELESYNERGY is also making an impact outside of the United States. "Internationally, TELESYNERGY has provided a major boost in both care and communication to the partners in the Ireland-Northern Ireland-NCI International Partnership in Cancer Care," said Dr. Coleman. "The consortium was established in 1999 to foster collaboration in cancer research between NCI, Ireland, and Northern Ireland. TELESYNERGY WorkStations have been set up at the three sites - St. Luke's Hospital, Dublin; Belfast City Hospital, Belfast; and NCI."
Medical staff at all sites consult through the system on radiation oncology cases and clinical trials and also take part in long-distance education programs. In one case, a consultant in Northern Ireland contacted experts at NCI on a rare cancer case - one the consultant had not seen in 25 years. "This connection had a direct effect on the treatment of this patient and led to improved quality of care," noted Dr. Robert Martino, a colleague of Dr. Kempner and lead author of a 2003 journal article about the program (Martino, RL, et al., Engineering in Medicine and Biology Society 2003, Proceedings).
"We've only begun to scratch the surface of the many ways in which telemedicine can be used to deliver diagnostic and treatment services in a variety of settings," said Dr. Coleman. "As more sites have the capabilities to join the network, we can also share the collective expertise of specialists in different types of cancers so that more patients will benefit from research advances."