title: The assessment of telemedicine to support outpatient palliative care in advanced cancer.
abstract: OBJECTIVE
  We aimed to examine telemedicine as a form of home and additional support for traditional outpatient care as a way to remotely monitor and manage the symptoms of patients with advanced cancer.
  
  
  METHODS
  In total, 12 patients were monitored through monthly consultations with a multidisciplinary healthcare team and weekly web conferences. To evaluate and treat pain and other symptoms, the Edmonton Symptom Assessment System (ESAS) was applied during all remote or in-person interviews.
  
  
  RESULTS
  During monitoring, the team contacted the patients on 305 occasions: there were 89 consultations at the hospital, 19 in-person assistances to the family (without the patient), 77 web conferences, 38 telephone calls, 80 emails, and 2 home visits. The mean monitoring time until death was 195 ± 175.1 days. Eight patients who completed the ESAS in all interviews had lower mean distress symptom scores according to web conferences than in person.
  
  
  CONCLUSIONS
  Telemedicine allowed greater access to the healthcare system, reduced the need to employ emergency services, improved assessment/control of symptoms, and provided greater orientation and confidence in the care given by family members through early and proactive interventions. Web conferencing proved to be a good adjuvant to home monitoring of symptoms, complementing in-person assistance.
authors.affiliation: Postgraduate Programme in Medical Sciences,State University of Rio de Janeiro,Rio de Janeiro,Brazil.
authors.forename: Lilian
authors.initials: L
authors.lastname: Hennemann-Krause
authors.affiliation: Postgraduate Programme in Medical Sciences,State University of Rio de Janeiro,Rio de Janeiro,Brazil.
authors.forename: Agnaldo José
authors.initials: AJ
authors.lastname: Lopes
authors.affiliation: Pedro Ernesto University Hospital, State University of Rio de Janeiro,Rio de Janeiro,Brazil.
authors.forename: Janete Alves
authors.initials: JA
authors.lastname: Araújo
authors.affiliation: Pedro Ernesto University Hospital, State University of Rio de Janeiro,Rio de Janeiro,Brazil.
authors.forename: Elisabeth Martins
authors.initials: EM
authors.lastname: Petersen
authors.affiliation: Postgraduate Programme in Medical Sciences,State University of Rio de Janeiro,Rio de Janeiro,Brazil.
authors.forename: Rodolfo Acatauassú
authors.initials: RA
authors.lastname: Nunes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods / Q000592:standards*; D005221:Fatigue / Q000175:diagnosis; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010146:Pain / Q000175:diagnosis; D010166:Palliative Care / Q000379:methods*; D036301:Qualitative Research; D017216:Telemedicine / Q000592:standards*
keywords: Cancer; Pain management; Palliative care; Symptoms assessment; Telemedicine