Highlights
- Telehealth for head and neck cancer (HNC) surveillance is less acceptable immediately post-treatment compared to in-person visits.
- Key barriers include technological challenges, perceived inadequacy of remote assessment, and emotional preference for face-to-face care.
- A hybrid surveillance model combining telehealth and in-person visits increases patient acceptability, particularly beyond two years post-treatment.
- Addressing health literacy and opportunity costs of in-person visits can enhance telehealth integration in HNC surveillance.
Background
Head and neck cancers (HNCs), encompassing malignancies of the oral cavity, oropharynx, larynx, hypopharynx, nasopharynx, and sinonasal tract, represent a significant global oncologic burden. Surveillance following curative treatment is critical for early detection of recurrence and management of treatment sequelae, with traditionally frequent in-person visits recommended. The COVID-19 pandemic accelerated the adoption of telehealth modalities across oncology disciplines, with evidence demonstrating feasibility, accessibility, and patient satisfaction in various chronic diseases. However, HNC patients exhibit notably low acceptance of telehealth for surveillance due to several unique challenges, including complex physical examination needs and psychological considerations. Understanding patients’ perceptions, barriers, and facilitators to telehealth use is crucial to optimizing surveillance care delivery and tailoring hybrid models.
Key Content
Chronological Development of Evidence for Telehealth in Oncology Surveillance
Early telehealth investigations in oncology primarily focused on feasibility and technologic implementation (2010–2015), demonstrating the potential for remote consultations to reduce travel burden without compromising basic care quality. Meta-analyses from 2016–2022 highlighted high patient satisfaction in chronic cancer follow-up but simultaneously underscored heterogeneity in specific cancer types and populations. During the COVID-19 era (2020–2023), regulatory and reimbursement expansions catalyzed widespread telehealth integration. Studies addressing digital literacy, financial toxicity, and opportunity costs became more prominent, revealing important socioeconomic and psychological factors influencing telehealth adoption.
Evidence Specific to Head and Neck Cancer Surveillance
Head and neck cancer surveillance presents distinct challenges due to the anatomical complexity requiring direct visualization and palpation unavailable via telehealth. The landmark qualitative study by Sethi et al. (2026) elucidated detailed patient perspectives on telehealth, enrolling 24 participants with early-stage squamous cell carcinoma who had completed curative treatment 3 to 24 months prior. Using semistructured interviews and validated instruments (BHLS, OOCAT, COST), the study identified seven major themes:
- Perceived Benefits: Convenience, reduced travel time, minimized exposure risk, and decreased financial burden.
- Barriers: Concerns about insufficient physical examination, technological difficulties especially for older patients, and emotional distance from clinicians.
- Technology Barriers: Varied digital literacy levels affected engagement; some patients lacked necessary equipment or stable internet.
- Opportunity Costs of In-Person Visits: Appointment-associated time off work, transportation logistics, and caregiver burden were significant.
- Patient Responses: Initial skepticism toward telehealth shifted to conditional acceptance with safety nets such as easy conversion to in-person visits.
- Factors Increasing Acceptability: Clear communication, user-friendly platforms, technical support, and clinician endorsement.
- Incongruence Between Data and Perceptions: Although quantitative measures showed low financial toxicity and moderate health literacy, patient perceptions underestimated telehealth benefits due to entrenched preferences for face-to-face care.
Importantly, participants expressed more readiness to embrace a hybrid model combining telehealth with periodic in-person assessment, especially after the first two years post-treatment when recurrence risk declines.
Integrating Patient-Reported Measures and Financial Considerations
The incorporation of PROs and tools like BHLS and COST provides objective assessment of factors influencing telehealth engagement. Higher health literacy correlates with better adaptation to telehealth technologies, while financial toxicity impacts willingness to adopt remote care options that could mitigate costs. Oncology opportunity costs assessed via OOCAT highlight the trade-offs patients face in clinical attendance, reinforcing the rationale for telehealth to relieve these burdens.
Comparison with Other Cancer Types and Chronic Conditions
Compared to cancers such as breast or colorectal, where telehealth follow-up is more widely accepted and supported by randomized trials, HNC patients demonstrate greater attachment to in-person visits due to the necessity for comprehensive physical exams and symptom management of complex treatment effects (e.g., dysphagia, speech impairment). This necessitates tailored surveillance frameworks that consider disease- and treatment-specific nuances.
Expert Commentary
The qualitative insights into patient perceptions underscore the multifaceted nature of telehealth acceptability in HNC surveillance. Clinicians must recognize the intersection of technological literacy, emotional needs, and clinical requirements unique to this population. Guideline bodies (e.g., NCCN, ASCO) are beginning to endorse telehealth as a component of survivorship care but advocate for individualized application based on disease risk and patient preference.
Mechanistically, the examination of anatomical sites for recurrence relies on direct visualization and tactile feedback, which telehealth platforms currently cannot replicate. Advancements in remote diagnostic tools (e.g., patient-operated endoscopic attachments, AI-enhanced imaging) may expand future telehealth feasibility. Additionally, psychological safety from in-person trusted relationships remains a barrier needing intentional communication strategies.
Strategies to enhance telehealth acceptability include:
- Providing technology training and support to overcome digital literacy gaps.
- Employing hybrid surveillance models that balance clinical needs with patient convenience, as supported by Sethi et al.’s findings.
- Addressing financial and logistic barriers that contribute to opportunity costs of in-person visits.
- Robust clinician endorsement to build trust in telehealth effectiveness.
Limitations of current evidence include small sample sizes, single-center designs, and lack of randomized trials specifically comparing telehealth versus in-person surveillance in HNC. Further research should focus on long-term outcomes, technology-enhanced remote examination, and multicultural patient perspectives.
Conclusion
Telehealth presents a promising adjunct to traditional surveillance in head and neck cancer, offering convenience and cost reduction, but is hindered by technological, clinical, and emotional barriers. The hybrid model combining telehealth and in-person care aligns with patient preferences, particularly beyond the immediate post-treatment phase. Clinicians and health systems should prioritize patient-centered approaches incorporating education, technological support, and flexible scheduling to optimize oncologic outcomes and quality of life in HNC survivors.
References
- Sethi HK, Diamond N, Najjar W, et al. Patient Perceptions of Telehealth Use in Head and Neck Cancer Surveillance. JAMA Otolaryngol Head Neck Surg. 2026 Jul 16. PMID: 42461641.
- Prvu Bettger J, Resnik LJ. Telehealth Interventions to Promote Health and Rehabilitation among Adults with Disabilities: A Systematic Review. Am J Phys Med Rehabil. 2020;99(8):711-730. PMID: 32645458.
- Kruse CS, Krowski N, Rodriguez B, Tran L, Vela J, Brooks M. Telehealth and Patient Satisfaction: A Systematic Review and Narrative Analysis. BMJ Open. 2017;7(8):e016242. PMID: 28830769.
- Bergman R, Ehrlich A, Pine MS, et al. Telemedicine in Otolaryngology During COVID-19: Early Lessons Learned From Child and Adult Care. Laryngoscope. 2021;131(5):E1503-E1509. PMID: 33522084.
- Martinez KA 2nd, Rood M, Jhangiani N, et al. Patterns of Use and Perceived Benefits and Barriers to Telehealth Care Among Children With Medical Complexity and Their Family Caregivers. Telemed J E Health. 2020;26(2):230-239. PMID: 31513665.
