Transforming On-Treatment Follow-Up Care: A Randomized Controlled Trial of Virtual Versus In-Person Visits Evaluating Clinical Outcomes, Patient-Reported Measures, and Telehealth Implementation

Telemedicine and telehealth services, operationally defined as patient-provider interactions conducted through telecommunication technologies, have experienced widespread integration across diverse medical specialties. Prior to the onset of the coronavirus disease 2019 (COVID-19) pandemic, numerous clinical disciplines had adopted telemedicine modalities to enhance healthcare accessibility and improve patient convenience. The COVID-19 pandemic and its aftermath have precipitated an unprecedented acceleration in the adoption of telehealth services, profoundly reshaping healthcare delivery paradigms across multiple disciplines.

As of 2025, Pakistan continues to grapple with a substantial cancer burden, with more than 185,000 new cases and over 125,000 cancer-related deaths reported annually. Despite ongoing efforts to improve awareness, early detection, and treatment accessibility, major challenges persist-particularly regarding healthcare access in rural regions and the financial burden associated with cancer treatment. For patients undergoing primary treatment, the costs of travel, accommodation, and sustenance during treatment and follow-up visits constitute significant barriers. These economic constraints frequently result in missed appointments and treatment discontinuation, thereby compromising the effectiveness of established therapeutic protocols.

Addressing these barriers necessitates a multifaceted approach, including the strategic expansion of telemedicine services. Telehealth can serve as a vital tool to bridge gaps in cancer care accessibility, ensuring that patients receive timely and continuous treatment regardless of geographic location or socioeconomic status.

Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) is a leading institution in Pakistan, delivering comprehensive oncologic care to a large patient population. In 2024 alone, approximately 83,000 patients received radiotherapy in neoadjuvant, adjuvant, or palliative settings, underscoring the hospital's pivotal role in cancer management. As a high-volume cancer center, effective coordination of follow-up appointments and the maintenance of accurate clinical documentation are essential tasks that require seamless collaboration between patients and healthcare professionals.

Patients undergoing radiation therapy at SKMCH&RC were consecutively recruited and randomly assigned to either a hybrid follow-up group, receiving one virtual and one in-person appointment, or a control group receiving only in-person follow-ups. Clinical and demographic information was obtained from patient records. Following each visit, patients completed an anonymous, validated questionnaire survey assessing satisfaction, communication, and convenience. Additional logistical data, including appointment adherence, visit duration, and any technical difficulties during virtual visits, were systematically documented. All collected data were anonymized and stored securely to maintain confidentiality and support robust analysis of telehealth integration in on-treatment care.