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Overman. J Cancer Metastasis Treat 2020;6:11 Journal of Cancer
DOI: 10.20517/2394-4722.2020.06 Metastasis and Treatment

Perspective Open Access

Letting go of the physical exam: embracing
telehealth solutions to oncology

Michael J. Overman

Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030,
USA.

Correspondence to: Michael J. Overman, Department of Gastrointestinal Medical Oncology, The University of Texas M. D.
Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA. E-mail: moverman@mdanderson.org
How to cite this article: Overman MJ. Letting go of the physical exam: embracing telehealth solutions to oncology. J Cancer
Metastasis Treat 2020;6:11. http://dx.doi.org/10.20517/2394-4722.2020.06
Received: 17 Jan 2020 First Decision: 27 Mar 2020 Revised: 12 Apr 2020 Accepted: 21 Apr 2020 Published: 28 Apr 2020

Science Editor: Pravin D. Potdar Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Despite the diminishing value of the physical exam in the management of many chronic diseases, it still
[1]
represents a core component of clinical office visits . In part, this reflects the reimbursement landscape
that continues to support its use at every clinical encounter. However, as healthcare pivots towards a new
focus on value-based care, it is imperative that we move beyond the confines of the in-person clinical
encounter and embrace the tremendous potential for telehealth solutions to healthcare delivery.

The management of chronic diseases frequently relies on the subjective component of care represented by
symptom management or the provision of information. In addition, in many chronic diseases, new diagnoses
are made based on objective measures of laboratory or imaging testing. This is particularly true in medical
oncology, where symptoms generally reflect well-defined toxicity profiles from anti-cancer systemic therapy
or the space-occupying effects of metastatic disease, which in almost all settings would be diagnosed via
imaging testing. In a medical oncology clinic, the two most common visit types are by patients undergoing
active systemic anti-cancer therapy or surveillance for potential cancer recurrence.

In the first setting, medical oncology providers spend their time managing various symptoms such as
nausea, fatigue, depression, anxiety, diarrhea, or pain. In addition, at almost all of these visits, laboratory
studies are conducted to provide adequacy of blood counts for treatment and chemistries to assess
dehydration. The critical aspects of these visits are subjective symptom assessment, laboratory review,
education related to symptom management, and the prescription of symptomatic medications and anti-
cancer therapy. The physical exam however, frequently represents time that is not allocated for symptom
management education. Without the need to see each patient in person, patients could have laboratory
testing, vital signs testing, and telehealth visits better integrated into their schedules. In fact, telehealth

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
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