Key takeaways:

• A randomized trial showed children and adolescents with cancer had similar safety outcomes with telehealth and in-person follow-up during intensive chemotherapy.
• Telehealth saved more than 40,000 km of travel.

Telehealth could substantially reduce travel burdens for children and adolescents with cancer undergoing intensive chemotherapy without significantly impacting safety.

A randomized trial in Germany showed that patients receiving virtual follow-up care saved more than 40,000 km combined, and they had similar rates of grade 3 or worse adverse events compared with those treated in-person.

Data derived from Schewe DM, et al. JCO Oncol Pract. 2026;doi:10.1200/OP-25-01303.

“This study argues for implementation of telemedicine in routine patient care even during intensive chemotherapy — which may ease life for patients, families and for hospitals,” Denis M. Schewe, MD, professor and head of pediatric hematology and oncology at University Hospital Carl Gustav Carus Dresden, told Healio.

‘Scarce’ evidence

The U.S. is projected to have approximately 15,000 new cancer cases in children and adolescents in 2025, according to the inaugural American Association for Cancer Research’s Pediatric Cancer Progress Report.

Outcomes have substantially improved in this population over the past 50 years, with 5-year OS increasing from 63% to 87%.

However, better treatments also have resulted in centralization of care for “quality assurance purposes,” Schewe explained.

“Therefore, travel distances for families with kids with cancer increase,” he said. “Oftentimes, such as in the case of leukemia, patients need to be seen several times per week in order to assess their medical status.”

Healio has previously reported on travel burdens patients with cancer may face, including one study that found roughly 7% of fee-for-service Medicare beneficiaries crossed state lines to receive care.

Prior research has shown that telehealth could alleviate some burdens. An intervention among patients from Brazil found telemedicine significantly improved physical function, mood and quality of life. Researchers described research investigating telehealth in children and adolescents with cancer as “scarce,” though.

Schewe and colleagues conducted a randomized phase 3 crossover trial to evaluate the safety of telemedicine among 55 patients with cancer aged 25 years and younger in Northern Germany. To be included, patients had to be receiving intensive chemotherapy, or they had to have a history of stem cell transplantation and be receiving immunosuppressive drugs.

Researchers randomly assigned participants to receive 3 months of telemedicine (n = 28; mean age, 8.4 years; standard deviation, 6.1; 64% male) or in-person visits (n = 27; mean age, 9.1 years; standard deviation, 6; 52% male) between June 2021 and May 2024. Patients then switched to the other method for the subsequent 3 months of care.

During the telemedicine phase of the trial, patients used an app and Bluetooth-enabled devices to monitor body temperature, heart rate and oxygen saturation.

Safety served as the primary endpoint. Symptom-to-antibiotic time served as the secondary endpoint.

‘Telemedical care is safe’

Overall, 47 patients completed the telemedicine portion of the study, 44 finished the in-person phase, and 43 participants completed both.

No patients discontinued the trial because of adverse events or dissatisfaction.

Patients had more visits during the telehealth portion of the study than the in-person (mean, 7.5 vs. 2.6).

Telemedicine visits accounted for 18% of all outpatient follow-ups.

Among patients with evaluable travel data, researchers found telehealth resulted in 337 avoided in-person visits and 42,288 km of travel saved.

Had all eligible follow-up visits been done through telehealth, 118 more hospital visits could have been averted, which would have prevented 13,321 km of travel.

Schewe and colleagues did not observe significant differences in grade 3 or worse adverse events between groups, or symptom-to-antibiotic time.

The most common grade 3 or worse adverse events included neutropenia (n = 84; 52% in telehealth phase) and gastrointestinal complications (n = 13; 54% in in-person phase).

“Telemedical care is safe in a very vulnerable patient population, and this may mean such models are expandable to all sorts of other populations, such as adults with cancer and far beyond,” Schewe said.

Researchers acknowledged study limitations, including the small sample size.

“Our next steps are the connection of telemedicine with home-diagnostics models, such as patients checking blood counts at home or similar. We are conducting such projects at our hospital,” Schewe said. “Also, this may be the start for hospital-at-home models, transferring even more parts of routine care to the home setting. We are considering mobile nurse systems, which, under telemedical control by the center, may be used to even apply therapies at home.”

For more information:

Denis M. Schewe, MD, can be reached at denis.schewe@ukdd.de.