Transforming postoperative follow-up: telemedicine trends in radical prostatectomy patients
Cassra B Clark1, Jessica Santucci1, Mackenzie Goldsmith1
1Department of Urology, Penn State College of Medicine, Penn State University, Hershey, PA, USA.
Background:
The coronavirus disease 2019 (COVID-19) pandemic ushered in the widespread adoption of telemedicine in the healthcare landscape. Telemedicine utilization has persisted beyond the pandemic and is considered an acceptable method of surveilling cancer patients. Oncologic surveillance following radical prostatectomy (RP) involves checking serum prostate specific antigen (PSA) and theoretically is well suited for telemedicine. We compare demographic data and clinical traits of patients undergoing in-person vs. telemedicine surveillance after prostatectomy.
Methods:
A retrospective cohort study of RP patients for a single surgeon with clinic visits occurring between January 2021-April 2024 was performed. For data entry and analysis, the most recent visit for each unique patient was used even if multiple visits occurred during the study. Patient distance from hospital was calculated using CDXGeoData API software and representative map produced on Google Maps. For bivariate statistical analysis, Wilcoxon Rank Sum test was used for continuous variables and Chi-squared and two sampled t-test were used for categorical variables. For multivariate statistical analysis, logistic regression was used.
Results:
Four hundred and ninety-one patients were included of which 283 (58%) visits were in-person and 208 (42%) were telemedicine. On bivariate analysis, compared to in-person visits, patients utilizing telemedicine lived a greater distance from the hospital (P<0.001). Race was significantly associated with visit modality (P=0.046), with White patients demonstrating higher utilization of telemedicine. In contrast, cancer recurrence (P=0.04) and active androgen deprivation therapy (ADT) use (P=0.01) were significantly associated with in-person encounters. Erectile dysfunction (ED), stress urinary incontinence (SUI), marital status, pathologic stage, and PSA nadir were not significantly associated with visit type. On multivariate analysis, only younger age [odds ratio (OR) 0.846, 95% confidence interval (CI): 0.742-0.964] and White race (OR 0.406, 95% CI: 0.182-0.907) were independently associated with telemedicine use.
Conclusions:
Telemedicine offers an effective and patient centric method of surveillance after RP. Targeted efforts are needed to address sociodemographic factors that influence its utilization.
