Impact of COVID-19 Pandemic on Cancer Screening in India: Current Situation, Challenges and Way Forwards
Cancer screening is a highly effective preventive measure that can reduce cancer incidence and mortality. COVID-19 pandemic has severely disrupted the ongoing screening activities for early diagnosis of cancers across the globe and the worst affected are low and middle income countries and India is no exception to it. This disruption to cancer screening services may have a significant impact on patients, health care practitioners, and health systems. Through this paper, we aim to offer a comprehensive view on the impact of COVID-19 on cancer screening in India and offer potential solutions to the problems arising out of the COVID-19 pandemic in cancer screening and prevention.
As of August 13, 2021, as per World health Organization (WHO), the COVID-19 pandemic has affected 222 countries and territories, with more than 205 million confirmed cases and more than 4.3 million deaths due to the disease . The ongoing COVID-19 pandemic has resulted in widespread mortality and has exposed the frailties of health-care systems worldwide. National responses have varied from country to country, with restrictions or lockdowns of varying severity were implemented to curb the pandemic, with different outcomes. There are concerns that several areas of health care, such as infant and maternal health, immunization, and non-communicable diseases could have been adversely affected by the pandemic [2, 3]. The reasons for these adverse consequences are multifactorial: health systems have been overwhelmed due to the prioritization of COVID-19 treatment over other diseases and the fear of COVID-19 transmission both among the general public and among the health-care providers has prevented care seeking. These effects are likely to be further compounded by the logistical challenges imposed on patients due to national and regional lockdowns and the economic slowdown and potential loss of wages.
On Jan 30th, 2020, the first case of COVID-19 was reported from India, and as of Aug 14th, 2021, around 32 million people have been infected with 430,254 individuals dying from the disease.1 In response to the pandemic, the Government of India instituted a series of nationwide lockdowns that began on March 24th, 2020, with severe restrictions imposed on inter-state and intra-state travel. Some cancer centers were partially or completely converted to COVID-19 treatment facilities. Data from cancer centers across the world have shown that the provision of oncology services has been considerably reduced during the COVID pandemic [4-6]. Projections from many countries indicate increases in mortality in the next 5–10 years due to delays in diagnosis for several different cancer types [7-9]. In India, around 1·32 million patients are diagnosed with cancer annually  and cancer accounts for 8% of all deaths in the country . Considerable disparities exist in cancer care in urban and rural areas [12-14]. Travel restrictions particularly during the first wave of the pandemic in India were likely to have affected access to care, especially for individuals in rural areas who are dependent on urban centres for cancer care. The coronavirus pandemic and the subsequent lockdowns have impacted not only cancer care but also the research in the field. The uncertainty has introduced new risks for cancer patients, disrupting the delivery of cancer treatment and the continuity of research.
Impact of COVID-19 on Cancer Screening in India
The pandemic has led to a challenging and unprecedented situation for those who did not know that they are having cancer or at risk of it. While cancer prevention and screening is integral to personal and population health, the cancer prevention and care sector is experiencing adverse changes due to the COVID-19 pandemic [15, 16]. One of the most severely impacted cancer control and prevention services is cancer screening. Cancer screening utilizes medical tests to identify precancerous lesions before cancer is developed or to detect cancer before it progresses into more advanced stages [17, 18]. Screening is an effective preventive strategy that could substantially reduce cancer incidence and mortality rates in patients [19-22]. Evidence shows that for women of all ages at average risk, screening is linked to an approximate 20% reduction in breast cancer mortality . Studies further indicate that 3 times the deaths resulting from colorectal cancer could be avoided with one third of current costs if colorectal cancer screening rates in people aged 50-70 years is improved to 80% . For the genetically predisposed individual, the benefit of prescribed cancer screening has an even greater impact [25, 26].
COVID-19 has significantly hampered the cancer screening infrastructure . To adjust the provision of health care resources, many cancer agencies have championed the idea of halting cancer screening services to patients [27-29]. In United states (US), it is estimated that as a result of COVID-19, screenings for cancers of the breast, colon, and cervix have dropped by 94%, 86%, and 94% between January 20, 2020, and April 21, 2020, respectively .
As per GLOBOCAN 2018, India alone contributed to 1,157,294 (13.2%) of the total cancer cases of the Asian continent (8,750,9321 cases) with more than one-third being oral, breast and cervical cancer cases . India has the highest estimated lip and oral cavity cancer cases worldwide (119,992, 33.8%) and the second-highest number of the breast (162,468, 17.8%) and cervix uteri (96,922, 30.7%) cancers in Asian sub-continent . Not only India has a high cancer burden, the majority (75-80%) of cancer patients have advanced disease (Stage 3-4) at the time of diagnosis owing to lack of screening services in most part of the country. Rural areas of India (where 69% of the total population resides) have an even worse situation, where cancer patients and families have to travel long distances to receive treatment and care at a tertiary care oncology center .
The government of India had launched an operational framework for the country’s first national cancer screening program in 2016 under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). As per the guidelines, there will be both population and facility based screening for oral, breast, and cervical cancer in people over the age of 30 in 100 districts of India before the program is expanded to other areas of the country [33, 34]. On 19th May 2020, due to the COVID-19 pandemic impact, the Government of India had suspended the population based screening of people above 30 years of age as part of the national program based on the risk associated with oral cavity examination. However, emergency cases requiring a biopsy will be addressed as per the protocol. These were temporary guidelines and subject to revision depending on change in the overall situation . Thereby, the early detection of cancer services were primarily be restricted to out-patient settings in primary, secondary and tertiary care centers.
Even before COVID-19 pandemic, population-based screening was confined to only few geographical regions in India due to various reasons including infrastructure and manpower constraints. Majority of cancer patients in India are diagnosed only when they visit hospital out-patient settings with early signs and symptoms . Therefore, it is necessary that early detection services should be kept functional at out-patient settings so that at least the patients coming to hospitals with early signs and symptoms can be diagnosed as early as possible.
Opportunities and Solutions
a) Use of Telemedicine for Cancer Screening & Prevention
With the advances in science and technology, the application of telemedicine in cancer care and management have gained momentum [37-39]. Telemedicine, literally means “healing at a distance” , could be understood as the delivery of health care services aiming to advance personal and population health . Telemedicine allows timely, accessible, and cost-effective health care delivery to patients, which qualifies itself a practical solution to the COVID-19–induced constraints such as social distancing and self-isolation [42-44]. Telemedicine tools such as virtual reality devices have been found to be useful for training health care practitioners . As virtual reality can offer remote yet realistic training experiences, it facilitates training for health care professionals in a time when social isolation is the norm. Telemedicine has been shown to be effective in underserved geographically remote populations. Emerging technologies such as artificial intelligence (AI) also have great potential in facilitating cancer screening . On a higher-technological state, using a deep learning technique, researchers found that AI can help identify faces of patients with cancer from those without . This promising finding, not currently in use, suggests that AI-based telemedicine tools have the future potential to assist patients and health care practitioners with cancer screening and improve screening accuracy.
While promising telemedicine opportunities are present, to successfully implement telemedicine in cancer care and primary care, education and training should be made available to both patients and health care practitioners . Research conducted by Stanford University shows that 47% of physicians and 73% of medical students surveyed indicated that they are considering taking additional courses to better prepare for innovations in health care (e.g.; data science, AI) . While it is of vital importance to update college curricula to reflect health care needs identified in practice [48, 49], it is important to understand that telemedicine education and training should be considered as a long-term investment, rather than a short-term experiment. In other words, as technology advances, telemedicine education and training programs should also be updated regularly and frequently to ensure health care practitioners are up to date with telemedicine opportunities for the benefits of self and patients [50, 51].
b) Leveraging Social Media to Boost Cancer Screening
In addition to boosting health care professionals’ core competence with respect to telemedicine, health systems should also consider adopting integrated marketing campaigns, such as social media campaigns, to increase screening awareness and adoption rates in patients. Social media campaigns could be understood as the use of social media platforms to deliver persuasive communication strategies to the target audience in order to change their attitudes and behavior to improve health. One key advantage of social media campaigns is that as persuasive strategies adopted in these campaigns are evidence-based and tailored to the target audience, [52, 53] they often yield desirable campaign outcomes [54-56].
Social media campaigns may be extremely useful for promoting cancer screening services to at-risk populations. Compared to integrated marketing campaigns distributed via traditional media platforms, social media campaigns can be distributed remotely with limited costs and therefore have the added advantages of cost-effectiveness and scalability [52, 53]. This advantage might be more pronounced in the era of COVID-19; since lockdowns and social distancing measures have limited people’s ability to physically disseminate campaign messages, campaign mechanisms that can virtually distribute promotional information are desired. Evidence suggests that social media campaigns are effective in raising cancer screening awareness in the target audience [57-59]. Promising findings show that social media campaigns on lung cancer screening using Google and Facebook to reach at-risk populations yielded click-through rates above the industry standard . These insights suggest that health care professionals can consider using social media campaigns to reach at-risk populations, such as marginalized communities with pronounced needs to be screened for cancer, to further address the widening cancer disparities exacerbated by COVID-19.
In conclusion, the systemic disruption and tragedy that COVID-19 has brought to patients, practitioners, and health care systems globally is a window of opportunity for innovative solutions’ in the field of cancer screening and prevention. Cancer prevention professionals need to innovate in the current changed environment in order to continue reducing the burden of cancers and sufferings arising out of them in communities. We need agile short-term plans tailored to the current COVID-19 situation as well as long-term plans that account for the capricious, costly, and deadly nature of cancer and its intersection with other widespread health problems, such as viral infections similar to the current pandemic. We offer some post–COVID-19 screening recommendations as follows:
• Breast cancer screening
• Educating the community through various channels on how to perform a “breast self-examination”
• Cervical cancer screening
• Visual inspection under acetic acid)(VIA)+/- Pap smears at the health facilities following COVID guidelines
• Oral cancer screening
• To be conducted by the health worker only if PPE kits are available at the health facility. Education through various medias and channels on how to self-examine the oral cavity and identify any “abnormal lesion”
• General solutions:
• Proactive outreach to patients due for screening or population at risk of cancer
• Social media communication to patients about risks of cancer and safety of screening procedures
• Initial assessment and results follow-up via telemedicine appointment
• Masking precautions (patient, clinician, and staff)
• Social distancing precautions wherever possible
Contentment is not a choice in the current situation, and health care professionals must diligently work together with other stakeholders and across disciplines to find solutions to ensure patients, providers, and health systems have the necessary tools and means to screen for cancer in the new changed scenario.
- WHO Coronavirus (COVID-19) Dashboard Available from: https://covid19.who.int/ [Last accessed on August 14, 2021]..
- Three further ways that the COVID-19 pandemic will affect health outcomes Watkins Johnathan, Wulaningsih Wahyu. International Journal of Public Health.2020;65(5). CrossRef
- The Untold Toll - The Pandemic's Effects on Patients without Covid-19 Rosenbaum Lisa. The New England Journal of Medicine.2020;382(24). CrossRef
- COVID-19 outbreak and cancer radiotherapy disruption in Italy: Survey endorsed by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Jereczek-Fossa Barbara Alicja, Pepa Matteo, Marvaso Giulia, Bruni Alessio, Buglione di Monale E Bastia Michela, Catalano Gianpiero, Filippi Andrea Riccardo, Franco Pierfrancesco, Gambacorta Maria Antonietta, Genovesi Domenico, Iatì Giuseppe, Magli Alessandro, Marafioti Luigi, Meattini Icro, Merlotti Anna, Mignogna Marcello, Musio Daniela, Pacelli Roberto, Pergolizzi Stefano, Tombolini Vincenzo, Trovò Marco, Ricardi Umberto, Magrini Stefano Maria, Corvò Renzo, Donato Vittorio. Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology.2020;149. CrossRef
- Early impact of the COVID-19 pandemic on paediatric cancer care in Latin America Vasquez Liliana, Sampor Claudia, Villanueva Gabriela, Maradiegue Essy, Garcia-Lombardi Mercedes, Gomez-García Wendy, Moreno Florencia, Diaz Rosdali, Cappellano Andrea M., Portilla Carlos Andres, Salas Beatriz, Nava Evelinda, Brizuela Silvia, Jimenez Soledad, Espinoza Ximena, Gassant Pascale Yola, Quintero Karina, Fuentes-Alabi Soad, Velasquez Thelma, Fu Ligia, Gamboa Yessika, Quintana Juan, Castiglioni Mariela, Nuñez Cesar, Moreno Arturo, Luna-Fineman Sandra, Luciani Silvana, Chantada Guillermo. The Lancet. Oncology.2020;21(6). CrossRef
- COVID's Impact on Radiation Oncology: A Latin American Survey Study Martinez David, Sarria Gustavo J., Wakefield Daniel, Flores Claudio, Malhotra Sameeksha, Li Benjamin, Ehmann Michael, Schwartz David L., Sarria Gustavo R.. International Journal of Radiation Oncology, Biology, Physics.2020;108(2). CrossRef
- The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study Maringe Camille, Spicer James, Morris Melanie, Purushotham Arnie, Nolte Ellen, Sullivan Richard, Rachet Bernard, Aggarwal Ajay. The Lancet. Oncology.2020;21(8). CrossRef
- Effect of delays in the 2-week-wait cancer referral pathway during the COVID-19 pandemic on cancer survival in the UK: a modelling study Sud Amit, Torr Bethany, Jones Michael E., Broggio John, Scott Stephen, Loveday Chey, Garrett Alice, Gronthoud Firza, Nicol David L., Jhanji Shaman, Boyce Stephen A., Williams Matthew, Riboli Elio, Muller David C., Kipps Emma, Larkin James, Navani Neal, Swanton Charles, Lyratzopoulos Georgios, McFerran Ethna, Lawler Mark, Houlston Richard, Turnbull Clare. The Lancet. Oncology.2020;21(8). CrossRef
- COVID-19 and cancer Sharpless Norman E.. Science (New York, N.Y.).2020;368(6497). CrossRef
- WHO International Agency for Research on Cancer. GLOBOCAN 2020. India Available from: https://gco.iarc.fr/today/data/factsheets/ populations/356-india-fact-sheets.pdf [Last accessed August 14, 2021]..
- The burden of cancers and their variations across the states of India: the Global Burden of Disease Study 1990-2016 Dhillon PK, Mathur P, Nandakumar A, et al . The Lancet. Oncology.2018;19(10). CrossRef
- Challenges to effective cancer control in China, India, and Russia Goss Paul E., Strasser-Weippl Kathrin, Lee-Bychkovsky Brittany L., Fan Lei, Li Junjie, Chavarri-Guerra Yanin, Liedke Pedro E. R., Pramesh C. S., Badovinac-Crnjevic Tanja, Sheikine Yuri, Chen Zhu, Qiao You-lin, Shao Zhiming, Wu Yi-Long, Fan Daiming, Chow Louis W. C., Wang Jun, Zhang Qiong, Yu Shiying, Shen Gordon, He Jie, Purushotham Arnie, Sullivan Richard, Badwe Rajendra, Banavali Shripad D., Nair Reena, Kumar Lalit, Parikh Purvish, Subramanian Somasundarum, Chaturvedi Pankaj, Iyer Subramania, Shastri Surendra Srinivas, Digumarti Raghunadhrao, Soto-Perez-de-Celis Enrique, Adilbay Dauren, Semiglazov Vladimir, Orlov Sergey, Kaidarova Dilyara, Tsimafeyeu Ilya, Tatishchev Sergei, Danishevskiy Kirill D., Hurlbert Marc, Vail Caroline, St Louis Jessica, Chan Arlene. The Lancet. Oncology.2014;15(5). CrossRef
- The growing burden of cancer in India: epidemiology and social context Mallath Mohandas K., Taylor David G., Badwe Rajendra A., Rath Goura K., Shanta V., Pramesh C. S., Digumarti Raghunadharao, Sebastian Paul, Borthakur Bibhuti B., Kalwar Ashok, Kapoor Sanjay, Kumar Shaleen, Gill Jennifer L., Kuriakose Moni A., Malhotra Hemant, Sharma Suresh C., Shukla Shilin, Viswanath Lokesh, Chacko Raju T., Pautu Jeremy L., Reddy Kenipakapatnam S., Sharma Kailash S., Purushotham Arnie D., Sullivan Richard. The Lancet. Oncology.2014;15(6). CrossRef
- Delivery of affordable and equitable cancer care in India Pramesh C. S., Badwe Rajendra A., Borthakur Bibhuti B., Chandra Madhu, Raj Elluswami Hemanth, Kannan T., Kalwar Ashok, Kapoor Sanjay, Malhotra Hemant, Nayak Sukdev, Rath Goura K., Sagar T. G., Sebastian Paul, Sarin Rajiv, Shanta V., Sharma Suresh C., Shukla Shilin, Vijayakumar Manavalan, Vijaykumar D. K., Aggarwal Ajay, Purushotham Arnie, Sullivan Richard. The Lancet. Oncology.2014;15(6). CrossRef
- Early Impact of COVID-19 on the Conduct of Oncology Clinical Trials and Long-Term Opportunities for Transformation: Findings From an American Society of Clinical Oncology Survey Waterhouse David M., Harvey R. Donald, Hurley Patricia, Levit Laura A., Kim Edward S., Klepin Heidi D., Mileham Kathryn Finch, Nowakowski Grzegorz, Schenkel Caroline, Davis Courtney, Bruinooge Suanna S., Schilsky Richard L.. JCO oncology practice.2020;16(7). CrossRef
- The challenges in colorectal cancer management during COVID-19 epidemic Ren Xianghai, Chen Baoxiang, Hong Yuntian, Liu Weicheng, Jiang Qi, Yang Jingying, Qian Qun, Jiang Congqing. Annals of Translational Medicine.2020;8(7). CrossRef
- Cancer: Screening. World Health Organization Available from: https://www.who.int/cancer/prevention/diagnosis-screening/screening/en/[Last accessed on August 14, 2021]..
- Division of Cancer Prevention and Control Screening tests. Centers for Disease Control and Prevention. 2020 Available from: https://www.cdc.gov/cancer/dcpc/prevention/screening.htm. [Last accessed on August 14, 2021]..
- Baseline Colonoscopy Findings Associated With 10-Year Outcomes in a Screening Cohort Undergoing Colonoscopy Surveillance Lieberman David, Sullivan Brian A., Hauser Elizabeth R., Qin Xuejun, Musselwhite Laura W., O'Leary Meghan C., Redding Thomas S., Madison Ashton N., Bullard A. Jasmine, Thomas Reana, Sims Kellie J., Williams Christina D., Hyslop Terry, Weiss David, Gupta Samir, Gellad Ziad F., Robertson Douglas J., Provenzale Dawn. Gastroenterology.2020;158(4). CrossRef
- Cost-Effectiveness of Colorectal Cancer Screening Strategies-A Systematic Review Ran Tao, Cheng Chih-Yuan, Misselwitz Benjamin, Brenner Hermann, Ubels Jasper, Schlander Michael. Clinical Gastroenterology and Hepatology: The Official Clinical Practice Journal of the American Gastroenterological Association.2019;17(10). CrossRef
- Effect of flexible sigmoidoscopy screening on colorectal cancer incidence and mortality: long-term follow-up of the randomised US PLCO cancer screening trial Miller Eric A., Pinsky Paul F., Schoen Robert E., Prorok Philip C., Church Timothy R.. The Lancet. Gastroenterology & Hepatology.2019;4(2). CrossRef
- Cervical Cancer Death Rates Among U.S.- and Foreign-Born Women: U.S., 2005-2014 Hallowell Benjamin D., Endeshaw Meheret, McKenna Matthew T., Senkomago Virginia, Razzaghi Hilda, Saraiya Mona. American Journal of Preventive Medicine.2019;56(6). CrossRef
- Benefits and Harms of Breast Cancer Screening: A Systematic Review Myers Evan R., Moorman Patricia, Gierisch Jennifer M., Havrilesky Laura J., Grimm Lars J., Ghate Sujata, Davidson Brittany, Mongtomery Ranee Chatterjee, Crowley Matthew J., McCrory Douglas C., Kendrick Amy, Sanders Gillian D.. JAMA.2015;314(15). CrossRef
- Cost-Effectiveness and National Effects of Initiating Colorectal Cancer Screening for Average-Risk Persons at Age 45 Years Instead of 50 Years Ladabaum Uri, Mannalithara Ajitha, Meester Reinier G. S., Gupta Samir, Schoen Robert E.. Gastroenterology.2019;157(1). CrossRef
- NCCN Guidelines Insights: Genetic/Familial High-Risk Assessment: Colorectal, Version 3.2017 Gupta Samir, Provenzale Dawn, Regenbogen Scott E., Hampel Heather, Slavin Thomas P., Hall Michael J., Llor Xavier, Chung Daniel C., Ahnen Dennis J., Bray Travis, Cooper Gregory, Early Dayna S., Ford James M., Giardiello Francis M., Grady William, Halverson Amy L., Hamilton Stanley R., Klapman Jason B., Larson David W., Lazenby Audrey J., Lynch Patrick M., Markowitz Arnold J., Mayer Robert J., Ness Reid M., Samadder Niloy Jewel, Shike Moshe, Sugandha Shajanpeter, Weiss Jennifer M., Dwyer Mary A., Ogba Ndiya. Journal of the National Comprehensive Cancer Network: JNCCN.2017;15(12). CrossRef
- NCCN Guidelines Insights: Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic, Version 1.2020 Daly Mary B., Pilarski Robert, Yurgelun Matthew B., Berry Michael P., Buys Saundra S., Dickson Patricia, Domchek Susan M., Elkhanany Ahmed, Friedman Susan, Garber Judy E., Goggins Michael, Hutton Mollie L., Khan Seema, Klein Catherine, Kohlmann Wendy, Kurian Allison W., Laronga Christine, Litton Jennifer K., Mak Julie S., Menendez Carolyn S., Merajver Sofia D., Norquist Barbara S., Offit Kenneth, Pal Tuya, Pederson Holly J., Reiser Gwen, Shannon Kristen Mahoney, Visvanathan Kala, Weitzel Jeffrey N., Wick Myra J., Wisinski Kari B., Dwyer Mary A., Darlow Susan D.. Journal of the National Comprehensive Cancer Network: JNCCN.2020;18(4). CrossRef
- ASBrS and ACR joint statement on breast screening exams during the COVID-19 pandemic The American Society of Breast Surgeons. 2020. Mar 26, [2020-09-01]. https://www.breastsurgeons.org/news/?id=45..
- Common questions about the new coronavirus outbreak. American Cancer Society. 2020. Oct 12, [2020-10-19] Falco M. https://www.cancer.org/latest-news/common-questions-about-the-new-coronavirus-outbreak.html..
- ASCCP interim guidance for timing of diagnostic and treatment procedures for patients with abnormal cervical screening test American Society for Colposcopy and Cervical Pathology. 2020. Mar 19, [2020-09-01]. https://www.asccp.org/covid-19..
- Preventive cancer screenings during COVID-19 pandemic. Epic Health Research Network. 2020 Available from: https://ehrn.org/delays-in-preventive-cancer-screenings-during-covid-19-pandemic/ [Last accessed on August 14, 2021]..
- International Agency for Research on Cancer, World Health Organization. GLOBOCAN 2018—estimated cancer incidence, mortality and prevalence worldwide in 2018. 2018 Available from: https://gco.iarc.fr/ [Last accessed on August 14, 2021]..
- Cancer research in India: Challenges & opportunities Singh Mayank, Prasad Chandra Prakash, Singh Thoudam Debraj, Kumar Lalit. The Indian Journal of Medical Research.2018;148(4). CrossRef
- India launches plan for national cancer screening programme Bagcchi Sanjeet. BMJ (Clinical research ed.).2016;355. CrossRef
- Director General of Health Services. Ministry of Health and Family Welfare. Government of India. National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). Published 2016 Available from: https://dghs.gov.in/content/1363_3_NationalProgrammePreventionControl.aspx[Last accessed on August 14, 2021]..
- Lockdown poses new challenges for cancer care in India Sharma Dinesh C. The Lancet. Oncology.2020;21(7). CrossRef
- Population-based cancer screening programmes in low-income and middle-income countries: regional consultation of the International Cancer Screening Network in India Sivaram Sudha, Majumdar Gautam, Perin Douglas, Nessa Ashrafun, Broeders Mireille, Lynge Elsebeth, Saraiya Mona, Segnan Nereo, Sankaranarayanan Rengaswamy, Rajaraman Preetha, Trimble Edward, Taplin Stephen, Rath G. K., Mehrotra Ravi. The Lancet. Oncology.2018;19(2). CrossRef
- Telemedicine in Cancer Care Sirintrapun S. Joseph, Lopez Ana Maria. American Society of Clinical Oncology Educational Book. American Society of Clinical Oncology. Annual Meeting.2018;38. CrossRef
- A Discussion of Virtual Reality As a New Tool for Training Healthcare Professionals Fertleman Caroline, Aubugeau-Williams Phoebe, Sher Carmel, Lim Ai-Nee, Lumley Sophie, Delacroix Sylvie, Pan Xueni. Frontiers in Public Health.2018;6. CrossRef
- Reaching high-risk underserved individuals for cancer genetic counseling by video-teleconferencing Mette Lindsey A., Saldívar Anna Maria Pulido, Poullard Natalie E., Torres Ivette C., Seth Sarah G., Pollock Brad H., Tomlinson Gail E.. The Journal of Community and Supportive Oncology.2016;14(4). CrossRef
- One hundred years of telemedicine: does this new technology have a place in paediatrics? Strehle E M, Shabde N. Archives of Disease in Childhood.2006;91(12). CrossRef
- Telemedicine: Opportunities and developments in member states. World Health Organization. 2010 Available from: https://www.who.int/goe/publications/goe_telemedicine_2010.pdf. [Last accessed on August 14, 2021]..
- Long-Term Institutional Experience With Telemedicine Services for Radiation Oncology: A Potential Model for Long-Term Utilization Lewis Gary D., Hatch Sandra S., Wiederhold Lee R., Swanson Todd A.. Advances in Radiation Oncology.2020;5(4). CrossRef
- Training doctors' social skills to break bad news: evaluation of the impact of virtual environment displays on the sense of presence Ochs Magalie, Mestre Daniel, Montcheuil Grégoire, Pergandi Jean-Marie, Saubesty Jorane, Lombardo Evelyne, FRANCON Daniel, Blache Philippe. Journal on Multimodal User Interfaces.2019;13(1). CrossRef
- Telemedicine, telehealth, and e-health technologies in cancer prevention Lopez Ana Maria. Fundamentals of Cancer Prevention, Third Edition.2014. CrossRef
- Design of a Culturally-Informed Virtual Human for Educating Hispanic Women about Cervical Cancer Mendu Sanjana, Boukhechba Mehdi, Gordon Janna R., Datta Debajyoti, Molina Edwin, Arroyo Gloria, Proctor Sara K., Wells Kristen J., Barnes Laura E.. International Conference on Pervasive Computing Technologies for Healthcare : [proceedings]. International Conference on Pervasive Computing Technologies for Healthcare.2018;2018. CrossRef
- Identification of the Facial Features of Patients With Cancer: A Deep Learning–Based Pilot Study Liang Bin, Yang Na, He Guosheng, Huang Peng, Yang Yong. Journal of Medical Internet Research.2020;22(4). CrossRef
- The rise of the data-driven physician. Stanford University Available from: https://med.stanford.edu/content/dam/sm/school/documents/Health-Trends Report/Stanford%20Medicine%20Health%20Trends%20Report%202020.pdf. [Last accessed on August 14, 2021]..
- The doctor is in, but is academia? Re-tooling IT education for a new era in healthcare Lee A, Moy L, Kruck SE, Rabang J. Journal of Information Systems Education.2014;25(4):275-282.
- Bridging healthcare education and technology solution development through experiential innovation Carroll Noel, Richardson Ita, Maloney Mairead, O'Reilly Pauline. Health and Technology.2017. CrossRef
- Information technologies in healthcare: Enhancing or dehumanising doctor-patient interaction? Botrugno Carlo. Health (London, England: 1997).2021;25(4). CrossRef
- Successful Integration of Information Technology in Healthcare: Guides for Managers Bidgoli Hossein. Journal of Strategic Innovation and Sustainability.2018;13(3). CrossRef
- The Role of Message Tailoring in the Development of Persuasive Health Communication Messages Noar SM, Harrington NG, Aldrich RS. Annals of the International Communication Association.2016;33(1):73-133.
- Use of mass media campaigns to change health behaviour Wakefield Melanie A., Loken Barbara, Hornik Robert C.. Lancet (London, England).2010;376(9748). CrossRef
- Upstream social marketing strategy: An integrated marketing communications approach Key TM, Czaplewski AJ. Business Horizons.2017;60(3):325-333.
- Improving integrated marketing communications practices: A comparison of objectives and results Patti c, Hartley s, van Dessel m, et al . Journal of Marketing Communications.2015;23(4):351-370.
- Pharmaceutical use according to participation in worksite wellness screening and health campaigns Merrill Ray M., Telford Carson T.. Preventive Medicine Reports.2018;12. CrossRef
- Implementation of Digital Awareness Strategies to Engage Patients and Providers in a Lung Cancer Screening Program: Retrospective Study Jessup DL, Glover Iv McKinley , Daye D, Banzi L, Jones P, Choy G, Shepard JO, Flores EJ. J Med Internet Res.2018;20(2):e52.
- EndCancer: development and pilot testing of multimedia recruitment for a text message campaign to increase cancer screening Harty Nicole M., Le Grice Kirstin, Cahill Christi, Bull Sheana, Dwyer Andrea. mHealth.2018;4. CrossRef
- Lung cancer screening: an emerging cancer control issue presents opportunities for an awareness campaign in rural Michigan Springer Steven M., McFall Angela, Hager Polly, Percy-Laury Antoinette, Vinson Cynthia A.. Cancer causes & control: CCC.2018;29(12). CrossRef
- Abstract viewed - 2191 times
- PDF (FULL TEXT) downloaded - 829 times
- XML downloaded - 0 times