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Page 2 of 3 Overman. J Cancer Metastasis Treat 2020;6:11 I http://dx.doi.org/10.20517/2394-4722.2020.06

experiences in other internal medicine subspecialties have demonstrated a reduction in driving time and
[2]
missed work . As well, systemic anti-cancer therapy represents a recurring event in patients’ lives so
optimization of their time should be our focus.

In the second context of surveillance, the physical exam is not needed when recent diagnostic imaging such
as computed tomographic scans have just been conducted. In addition, when tumor markers are normal
and a patient does not have new symptoms, a physical exam is of questionable value.

In essence, by tailoring in person clinic visits towards when there is highest need, we can help to integrate
our delivery of care into the lives of our patients better. In medical oncology where patients’ lives are often
measured in months or years, this improved integration would reflect a higher quality of life away from
the medical system for our patients. This change in approach would also align with where many medical
oncologists feel we need to be spending our time: educating our patients about symptom management
and their cancer journey. Such time spent on cancer prognosis, end-of-life experience, clinical-trial
understanding, symptom prevention and management should reduce the downstream utilization of high
cost emergent care facilities and hospitalizations during and at the end of life. The ability to tailor visits to
the needs of patients would enable in person visits to be reserved and dedicated to the critical discussions
of end-of-life care planning, prognostication discussions or restaging discussions.

Making such changes to a medical oncology clinic to be fully integrated with telehealth delivery will not
[3]
be easy as technological, liability, financial, and logistic scheduling challenges will exist . In addition,
the physical examination still has a symbolic meaning to patients as an acknowledgment of their
[4]
complaints and an expected part of a physician office visit . Studies have also demonstrated that the
[5]
physical examination is a way for physicians to build empathetic relationships with their patients . These
concerns will need to be addressed and discussed with patients as telehealth moves forward. Could open
acknowledgment of the missing aspect of touch and examination be a mechanism to attenuate this loss?

As we move towards a vision where we optimally integrate our practice with the lives of our patients, we
must first agree to move away from our historical reliance on the physical examination. It is time taken not
only to optimize a patients’ time at the end of life, but also to optimize their time throughout the entire
cancer care journey.

DECLARATIONS
Authors’ contributions
The author contributed solely to the article.

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
The author declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.