COVID-19 as a Natural Experiment in Virtual Oncology Care and Head and Neck Cancer Outcomes

Objectives: Oncology rapidly adopted telemedicine during COVID‑19, with limited outcome data. Prior work from our group reported the feasibility of telehealth consultations for head-and-neck cancer, one of the most challenging subsites to forego face-to-face encounters. Telemedicine remains an important mode of health care delivery, but data are lacking on cancer outcomes with entry into the treatment pathway through virtual versus conventional in-person consultations. We aimed to address the evidence gap by evaluating cancer outcomes in a homogeneous group of patients with oropharyngeal cancer (OPC) who underwent virtual new-patient consultations. Methods: Prospective nonrandomized cohort study at a multistate comprehensive cancer center. The telemedicine (TELE) cohort comprised 41 consecutive radiation oncology OPC consultations from 3/2020 to 9/2020; the standard in‑person (STIP) cohort included 104 patients from 10/2019 to 9/2020 with balanced baseline clinicopathologic features. Follow‑up ended May 31, 2025 (median: 57.0 mo). Primary endpoints included 3-year outcomes: locoregional control (LRC), distant metastasis-free survival (DMFS), progression-free survival (PFS), and cancer-specific survival (CSS). The following quality-of-care metrics were evaluated: time to initiation of treatment, clinical trial enrollment, and feeding tube placement. Results: There were no differences in 3-year outcomes between TELE and STIP cohorts: LRC (92.3% vs. 97.0%, P =0.50), DMFS (92.5% vs. 90.6%, P =0.65), PFS (87.5% vs. 88.6%, P =0.88), and CSS (97.4% vs. 95.9%, P =0.95). There were no differences in care quality indicators. Conclusions: Telemedicine new patient oncology consultations did not compromise OPC outcomes or care quality. These findings from a pandemic-driven natural experiment support virtual oncology consultations as a viable form of patient-centered care and may encourage telemedicine outcomes studies across other specialties.