# Community-Based Telehealth Approach Improves Specialist Access for Individuals with Increased Cancer Risk in Low-Resource Settings

## TL;DR

A community-based Telehealth system improves specialist access for people at high risk of oral cancer in low-resource areas.

## Contribution

A novel, low-cost Telehealth platform is introduced to increase specialist referral compliance in underserved populations.

## Key findings

- Telehealth had significantly higher compliance rates at 1 month (p = 0.0006) and 3 months (p = 0.0154) compared to in-person visits.
- 20 out of 24 Telehealth users completed a remote specialist visit within 3 months, versus only 7 out of 16 in-person users.

## Abstract

Individuals in low-resource settings carry a disproportionately high risk of oral cancer, yet they lack access to specialist diagnosis and care, leading to poor outcomes. While inadequate screening accuracy presents one barrier to better outcomes, another major hurdle is poor specialist referral compliance. The goal of this prospective study was to evaluate the impact of a novel Telehealth platform on specialist referral compliance. The prototype Telehealth system is tailored for use in non-specialist community settings. Of the 40 subjects with increased oral cancer risk who were enrolled in this study, 24 opted for Telehealth, and 20/24 completed a remote specialist visit within 3 months. Sixteen selected an in-person specialist visit, and seven of the sixteen attended their in-person visit within 3 months. Significantly more individuals complied with Telehealth specialist referral at 1 month (p = 0.0006) and after 3 months (p = 0.0154). Based on these results, this tailored community-based Telehealth platform may improve specialist access in individuals from low-resource settings undergoing specialist referral for increased oral cancer risk.

Background/Objectives: The low-resource, minority and underserved populations (LRMU) that carry the highest risk of oral cancer (OC) experience many barriers to early detection and treatment, resulting in disproportionately poor outcomes. One major barrier to better outcomes is poor compliance with specialist referral for diagnosis and treatment. The goal of this prospective study was to compare specialist referral compliance for Telehealth vs. in-person visits in LRMU individuals screening positive for increased OC risk. Methods: Forty subjects who had screened positive for oral potentially malignant lesions (OPMLs) were recruited from community clinics. The subjects indicated whether they would prefer an in-person or Telehealth specialist visit. They were offered assistance with all aspects of the visit, and then tracked over 3 months for referral compliance. A novel, very low-cost, simple Telehealth platform located within the community clinic was used for the remote specialist visits. Results: In the Telehealth group, 16/24 subjects attended their first scheduled remote specialist visit; 4/24 attended rescheduled visits within 3 months, and 4/24 did not comply at all. All attendees and specialists were able to complete the remote visits in full. Of the 7/16 subjects who completed in-person visits, 3/16 attended their first scheduled visit, and 4/16 complied within 3 months; 9/16 subjects did not comply at all with specialist referral. Significantly more individuals complied with Telehealth specialist referral at 1 month (p = 0.0006) and after 3 months (p = 0.0154). Conclusions: This novel Telehealth platform may improve compliance with specialist referral in low-resource individuals with OPMLs.