Introduction: Breast cancer-related lymphoedma is a common complication post-breast cancer surgery, with early identification of risks and intervention critical. The COVID-19 pandemic necessitated the conversion of many outpatient post-operative surveillance clinics to telehealth. To evaluate the effectiveness of this mode of delivery, the aim of this prospective cohort study was to compare the identification of complications during telehealth appointments versus face-to-face appointments. Client satisfaction was also examined.
Methods: Fifty-six females diagnosed with breast cancer and attending a breast surgery pre-admission clinic attended two modes of assessment: telehealth and face-to-face, 2-7 days apart, within four weeks post-surgery. The following complications were assessed as present or not: scar healing, infection, shoulder range of motion (ROM), cording, swelling and pain. An online satisfaction survey was completed after each appointment. Observed agreement and Gwet’s AC1 coefficients were used to examine the agreement in complication identification between modes of assessment. A priori agreement coefficient of ≥80% was deemed clinically acceptable.
Results: Agreement between telehealth and face-to-face appointments met the criteria for acceptability for: scar healing (AC1 coefficient 0.98, 95%CI 0.94-1.00), infection (0.96, 95%CI 0.90-1.00) and shoulder ROM (0.95, 95%CI 0.87-1.00). However, swelling (0.59, 95%CI 0.36- 0.82), cording (0.71, 95%CI 0.51-0.90) and pain (0.79, 95%CI 0.63-0.95) did not meet this criteria. Eighty-nine percent (n=39/44) and 97.7% (n=43/44) of participants agreed or strongly agreed they would use telehealth again, and it was convenient for them to attend via telehealth, respectively. Sixty-seven percent (n=34/51) of participants preferred the face-to-face appointment.
Conclusion: Telehealth appointments were accurate in identifying complications related to scar healing, infection and ROM early post-breast cancer surgery; however, further work is required to accurately detect swelling, cording and pain complications during this mode of appointment. Clear reasons for discrepancies can be addressed. This will ensure people following breast cancer surgery can access convenient and efficient care.