The safety and acceptability of using telehealth for follow-up of patients following cancer surgery: A systematic review

Published:September 08, 2022DOI:



      Although virtual consultations have played an increasing role in delivery of healthcare, the COVID-19 pandemic has hastened their adoption. Furthermore, virtual consultations are now being adopted in areas that were previously considered unsuitable, including post-operative visits for patients undergoing major surgical procedures, and surveillance following cancer operations. This review aims to examine the feasibility, safety, and patient satisfaction with virtual follow-up appointments after cancer operations.


      A systematic review was conducted along PRISMA guidelines. Studies where patients underwent surgical resection of a malignancy with at least one study arm describing virtual follow-ups were included. Studies were assessed for quality. Outcomes including adverse events, detection of recurrence and patient and provider satisfaction were assessed and compared for those undergoing virtual or in-person post-operative visits.


      Eleven studies, with 3369 patients were included. Cancer types included were gynecological, colorectal, esophageal, lung, thyroid, breast, prostate and major HPB resections. Detection of recurrence and readmission rates were similar when comparing virtual consultations with in-person visits. Most studies showed high patient and healthcare provider satisfaction with virtual consultations following cancer resection. Concerns were raised about the integration of virtual consultations into workflows in fee-for-service settings, where reimbursement for virtual care may be an issue.


      Virtual follow-up care can provide timely and safe consultations in surgical oncology. Virtual consultations are as safe as in-person visits for assessing complications and recurrence. Where appropriate, virtual consultations can safely be integrated into the post-operative care pathway for those undergoing resection of malignancy.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to European Journal of Surgical Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • El Bcheraoui C.
        • Weishaar H.
        • Pozo-Martin F.
        • Hanefeld J.
        Assessing COVID-19 through the lens of health systems' preparedness: time for a change.
        Glob Health. 2020; 16: 112
        • Chen-See S.
        Disruption of cancer care in Canada during COVID-19.
        Lancet Oncol. 2020; 21: e374
        • Carvalho A.S.
        • Fernandes Ó Brito
        • de Lange M.
        • Lingsma H.
        • Klazinga N.
        • Kringos D.
        Changes in the quality of cancer care as assessed through performance indicators during the first wave of the COVID-19 pandemic in 2020: a scoping review.
        BMC Health Serv Res. 2022; 22: 786
        • Haldane V.
        • De Foo C.
        • Abdalla S.M.
        • Jung A.S.
        • Tan M.
        • Wu S.
        • et al.
        Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries.
        Nat Med. 2021; 27: 964-980
        • Knudsen K.E.
        • Willman C.
        • Winn R.
        Optimizing the use of telemedicine in oncology care: post-pandemic opportunities.
        Clin Cancer Res. 2021; 27: 933-936
        • Mechanic O.J.
        • Persaud Y.
        • Kimball A.B.
        Telehealth systems.
        in: StatPearls. StatPearls Publishing, 2022
        • Nelson S.E.
        • Steuernagle J.
        • Rotello L.
        • Nyquist P.
        • Suarez J.I.
        • Ziai W.
        COVID-19 and telehealth in the intensive care unit setting: a survey.
        BMC Health Serv Res. 2022; 22: 797
        • Hays R.D.
        • Skootsky S.A.
        Patient experience with in-person and telehealth visits before and during the COVID-19 pandemic at a large integrated health system in the United States.
        J Gen Intern Med. 2022; 37: 847-852
        • Miller R.C.
        • Simone B.A.
        • Lombardo J.F.
        • Taylor J.
        • Nowak-Choi K.
        • Ko K.
        • et al.
        A pilot trial using telemedicine in radiation oncology: the future of health care is virtual.
        Telemedicine Reports. 2021; 2: 171-178
        • Uppal A.
        • Kothari A.N.
        • Scally C.P.
        • Roland C.L.
        • Bednarski B.K.
        • Katz M.H.G.
        • et al.
        Adoption of telemedicine for postoperative follow-up after inpatient cancer-related surgery.
        JCO Oncology Practice. March 9, 2022; (OP.21.00819)
      1. Treatment for cancer | cancer treatment options.
        • Debela D.T.
        • Muzazu S.G.
        • Heraro K.D.
        • Ndalama M.T.
        • Mesele B.W.
        • Haile D.C.
        • et al.
        New approaches and procedures for cancer treatment: current perspectives. vol. 9. SAGE Open Med, 202120503121211034370
        • Dührsen U.
        • Deppermann K.M.
        • Pox C.
        • Holstege A.
        Evidence-based follow-up for adults with cancer.
        Dtsch Arztebl Int. 2019; 116: 663-669
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • Group T.P.
        Preferred reporting Items for systematic reviews and meta-analyses: the PRISMA statement.
        PLoS Med. 2009; 6e1000097
        • Jadad A.R.
        • Moore R.A.
        • Carroll D.
        • Jenkinson C.
        • Reynolds D.J.
        • Gavaghan D.J.
        • et al.
        Assessing the quality of reports of randomized clinical trials: is blinding necessary?.
        Contr Clin Trials. 1996; 17: 1-12
      2. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for NON-randomized studies (MINORS): :5.

        • Malcolm F.L.
        • Adiamah A.
        • Banerjea A.
        • Whitehead D.
        • Gupta A.
        • West J.
        • et al.
        Long-term health-related quality of life following colorectal cancer surgery: patient-reported outcomes in a remote follow-up population.
        Colorectal Dis. 2021; 23: 213-225
        • Cerfolio R.J.
        • Ferrari-Light D.
        • Shah S.
        Telemedicine in thoracic surgery.
        J Vis Surg. 2019; 5 (0)
        • Beaver K.
        • Williamson S.
        • Sutton C.
        • Hollingworth W.
        • Gardner A.
        • Allton B.
        • et al.
        Comparing hospital and telephone follow-up for patients treated for stage–I endometrial cancer (ENDCAT trial): a randomised, multicentre, non-inferiority trial.
        BJOG An Int J Obstet Gynaecol. 2017; 124: 150-160
        • Beaver K.
        • Campbell M.
        • Williamson S.
        • Procter D.
        • Sheridan J.
        • Heath J.
        • et al.
        An exploratory randomized controlled trial comparing telephone and hospital follow-up after treatment for colorectal cancer.
        Colorectal Dis. 2012; 14: 1201-1209
        • Mole G.
        • Murali M.
        • Carter S.
        • Gore D.
        • Broadhurst J.
        • Moore T.
        • et al.
        A service evaluation of specialist nurse telephone follow-up of bowel cancer patients after surgery.
        Br J Nurs. 2019; 28: 1234-1238
        • Siddika A.
        • Tolia-Shah D.
        • Pearson T.E.
        • Richardson N.G.B.
        • Ross AHMcL.
        Remote surveillance after colorectal cancer surgery: an effective alternative to standard clinic-based follow-up.
        Colorectal Dis. 2015; 17: 870-875
        • Viers B.R.
        • Lightner D.J.
        • Rivera M.E.
        • Tollefson M.K.
        • Boorjian S.A.
        • Kernes R.J.
        • et al.
        Efficiency, satisfaction, and costs for remote video visits following radical prostatectomy: a randomized controlled trial.
        Eur Urol. 2015; 68: 729-735
        • Noble N.
        • Mackenzie L.
        • Carey M.
        • Proietto A.
        • Sanson-Fisher R.
        • Walker G.
        • et al.
        Cross-sectional survey to inform the development of a telehealth support model: a feasibility study for women undergoing breast cancer surgery.
        Pilot and Feasibility Studies. 2019; 5: 46
        • Neeman E.
        • Kumar D.
        • Lyon L.
        • Kolevska T.
        • Reed M.
        • Sundaresan T.
        • et al.
        Attitudes and perceptions of multidisciplinary cancer care clinicians toward telehealth and secure messages.
        JAMA Netw Open. 2021; 4e2133877
        • Bertolaccini L.
        • Prisciandaro E.
        • Guarize J.
        • Spaggiari L.
        A proposal for a postoperative protocol for the early diagnosis of bronchopleural fistula after lung resection surgery.
        J Thorac Dis. 2021; 13: 6495-6498
        • Ugurel S.
        • Enk A.
        Skin cancer: follow-Up, rehabilitation, palliative and supportive care.
        JDDG J der Deutschen Dermatol Gesellschaft. 2008; 6: 492-499
        • Elit L.
        • Fyles A.W.
        • Oliver T.K.
        • Devries–Aboud M.C.
        • Fung-Kee-Fung M.
        Follow-up for women after treatment for cervical cancer.
        Curr Oncol. 2010; 17: 65-69
        • McVay M.R.
        • Kelley K.R.
        • Mathews D.L.
        • Jackson R.J.
        • Kokoska E.R.
        • Smith S.D.
        Postoperative follow-up: is a phone call enough?.
        J Pediatr Surg. 2008; 43: 83-86
        • Gray R.T.
        • Sut M.K.
        • Badger S.A.
        • Harvey C.F.
        Post-operative telephone review is cost-effective and acceptable to patients.
        Ulster Med J. 2010; 79: 76-79
        • Fallaize R.C.
        • Tinline-Purvis C.
        • Dixon A.R.
        • Pullyblank A.M.
        Telephone follow-up following office anorectal surgery.
        Ann R Coll Surg Engl. 2008; 90: 464-466
        • Thompson-Coon J.
        • Abdul-Rahman A.K.
        • Whear R.
        • Bethel A.
        • Vaidya B.
        • Gericke C.A.
        • et al.
        Telephone consultations in place of face to face out-patient consultations for patients discharged from hospital following surgery: a systematic review.
        BMC Health Serv Res. 2013; 13: 128
        • Roberts T.J.
        • Lennes I.T.
        Lessons for oncology from the COVID-19 pandemic: operationalizing and scaling virtual cancer care in health systems.
        Cancer J. 2022; 28: 125-133
        • Teteh D.K.
        • Barajas J.
        • Ferrell B.
        • Zhou Z.
        • Erhunmwunsee L.
        • Raz D.J.
        • et al.
        The impact of the COVID-19 pandemic on care delivery and quality of life in lung cancer surgery.
        J Surg Oncol. 2022; (Published online April 23)
        • Kraus E.J.
        • Nicosia B.
        • Shalowitz D.I.
        A qualitative study of patients' attitudes towards telemedicine for gynecologic cancer care.
        Gynecol Oncol. 2022; 165: 155-159
        • Pareek P.
        • Vishnoi J.R.
        • Kombathula S.H.
        • Vyas R.K.
        • Misra S.
        Teleoncology: the youngest pillar of oncology.
        JCO Glob Oncol. 2020; 6 (GO.20.00295)
        • Wehrle C.J.
        • Lee S.W.
        • Devarakonda A.K.
        • Arora T.K.
        Patient and physician attitudes toward telemedicine in cancer clinics following the COVID-19 pandemic.
        JCO Clinical Cancer Informatics. 2021; : 394-400