# Minimizing Travel Burden of Gynecologic Cancer Surveillance Through a Unique Multidisciplinary Telehealth Program

## TL;DR

A new telehealth program for gynecologic cancer care reduces travel for rural patients while maintaining quality and satisfaction.

## Contribution

Introduces STEEL MAGNOLIAS, a hybrid telehealth model that reduces travel burden and ensures guideline adherence in rural gynecologic cancer surveillance.

## Key findings

- Patients traveled a median of 16.9 miles for STEEL MAGNOLIAS versus 137 miles for in-person visits.
- 82.5% of patients were alive with no evidence of disease.
- 76.9% of appointments adhered to NCCN follow-up guidelines.

## Abstract

A unique multidisciplinary telehealth program is feasible, provides quality gynecologic cancer care, and significantly reduces travel burden for rural patients.

STEEL MAGNOLIAS (shared telehealth for multidisciplinary gynecologic cancer survivorship) is a novel gynecologic cancer surveillance care–delivery program in which rural patients see a close-by gynecologist in person with simultaneous virtual gynecologic oncology consultation. This study assesses feasibility of STEEL MAGNOLIAS by examining travel burden reduction, cancer outcomes, visit activities, guideline adherence, and patient satisfaction.

We retrospectively reviewed charts of patients with gynecologic cancer in remission under the STEEL MAGNOLIAS program in rural south Louisiana (March 2020–September 2023). Travel metrics, patient satisfaction, cancer outcomes, survival status, reasons for visit, and adherence to follow-up as per National Comprehensive Cancer Network (NCCN) guidelines were recorded. A small subset of patients prospectively completed questionnaires, such as the COST-FACIT (Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy) for financial toxicity and the PSQ-18 (Patient Satisfaction Questionnaire Short Form), and responded to questions about existing barriers to care. Descriptive statistics and Wilcoxon rank sum tests for continuous data were used. We assessed feasibility by assessing continued patient compliance without erosion of satisfaction.

Sixty-three patients attended 178 STEEL MAGNOLIAS appointments, and most of the patients had a history of endometrial cancer. The majority, 82.5%, were alive with no evidence of disease. Our patients traveled a median of 16.9 miles for STEEL MAGNOLIAS, compared with 137 miles for in-person visits. We identified prevalent transportation and technology barriers to in-person and conventional virtual visits. Patients demonstrated high satisfaction with appointments. Genitourinary and cancer therapy symptoms and reviews of laboratory test results and imaging often were discussed. Laboratory tests, imaging, and referrals were ordered and completed at high rates, with 76.9% of appointments adhering to NCCN follow-up guidelines.

The STEEL MAGNOLIAS program is a feasible, innovative hybrid telehealth model for rural gynecologic cancer surveillance that reduces travel burdens and ensures high guideline adherence and patient satisfaction. This scalable model has potential to improve outcomes and compliance, meeting patients where they are and transforming cancer survivorship.