Rheumatologists are seeing the number of telehealth visits skyrocket in their practices as the COVID-19 pandemic rages on and patients seek out alternatives to in-person visits. Telemedicine makes it easier for patients to connect with physicians, but not all patients have access to a computer or device. It also limits what a physician can do. Rheumatologists often rely on physical exams to make diagnoses and treatment decisions – an obstacle if you’re looking at patients through a computer screen.

FatCamera/E+

Presenters at the 2020 Coalition of State Rheumatology Organizations’ state advocacy conference discussed the benefits and challenges of this mode of care in early September. Within weeks, the U.S. health system eliminated almost half of all medical care as the pandemic ramped up and things went virtual, said Larry Van Horn, PhD, MPH, a speaker at the CSRO conference. Still, “we are in uncharted territory with respect to how telehealth is being used. ... It’s being deployed everywhere, but it’s too early to tell how it’s affecting patient outcomes,” said Dr. Van Horn, founder and director of the Center of Health Care Market Innovation at Vanderbilt University, Nashville, Tenn.

Patients seem to like using telemedicine, observed New Jersey state Sen. Herb Conaway, MD, another presenter. “I think it’s here to stay, and it’s likely to expand going forward. But physicians and others are going to want to make sure it’s used appropriately.”

Some payers feel that telemedicine should be billed differently than brick and mortar visits, Dr. Conaway said. “Physicians feel differently about that, and so we’ll see how this goes, moving forward.”

Lately, there have been discussions of liability concerns associated with telemedicine, said CSRO President Madelaine A. Feldman, MD, who practices in New Orleans. “There are some things you can miss with virtual visits. Certain new patient visits may need to be done in person.”
 

The landscape of telehealth in rheumatology

Telehealth has directly affected the way rheumatologists do business. In a national survey of more than 1,100 adult patients, the American College of Rheumatology found that 66% are choosing telehealth for rheumatology visits, mainly to avoid exposure to the SARS-CoV-2 virus. This contrasts with a 52% decline in the percentage of patients who are currently seeing a rheumatologist since 2019. “The pandemic has altered almost every aspect of our rheumatology practices,” said ACR President Ellen Gravallese, MD in a statement. “It has impacted our patients’ lives significantly and required us to create new ways of delivering care through improved telehealth and other adaptations.”

While many rheumatologists have resumed in-person visits, “others, like myself, are doing a hybrid,” Dr. Feldman said.

At the height of the pandemic in New York City, Elana J. Bernstein, MD’s practice relied entirely on telehealth visits. “We weren’t seeing any patients in the office for a couple of months. Now that things have reopened here, we’ve resumed face-to-face visits,” keeping some telehealth visits for patients who are still uncomfortable with in-person visits or who live far away, Dr. Bernstein, director of the scleroderma program at Columbia University, New York, said in an interview. She estimates that telehealth represents about 20%-30% of her practice right now.
 

Advantages, drawbacks of telehealth

For patients in underserved or geographically distant areas, telehealth means access to care, Kanika Monga, MD, of the University of Texas Health Science Center, Houston, said in an interview. During the COVID-19 public health crisis, “it has allowed the most vulnerable patient populations to continue receiving care at the click of a button.”

Virtual visits also improve patient care by improving follow-up and compliance, Dr. Monga continued. “For example, in our patient population, mobility can be a major issue because of the underlying disease. Telemedicine improves care for patients who struggle to make it to appointments.” It’s also more convenient for patients in her county that depend on arranged and/or public transportation and have to request a portion of their day off work for a doctor’s appointment.

But the virtual visit has its drawbacks. Different available platforms and their usability create challenges, Dr. Monga said. “Although some patients are tech-savvy, some are not. This is a challenge, especially when using platforms that have many steps involved.” Telemedicine also highlights general health inequities that already exist in some populations. Patients who are older, live in rural areas, are less educated, or are from a lower socioeconomic household might not have the technology or Internet connection available to enable telemedicine visits.

Telemedicine also complicates the physical examination, which is a central part of the diagnostic process, Dr. Bernstein said. Some components of the physical exam lend themselves to a video visit, such as evaluating for facial rashes or examining a patient’s digital ulcers. “But if you suspect the patient has rheumatoid arthritis, for example, you can’t examine the joints for swelling.” When seeing scleroderma patients over telemedicine, “I can’t perform the modified Rodnan skin score to assess for skin thickening, or auscultate the lungs for crackles. It’s also hard to assess a patient’s response to therapy over telemedicine,” Dr. Feldman added.

Some rheumatologists have sought out multiple pathways on telemedicine to provide more options for patients.

Christine Peoples, MD, clinical assistant professor of medicine at the University of Pittsburgh Medical Center, uses several telehealth options to reach patients that live in the largely rural area she serves. For her, telemedicine isn’t a novel concept. “I’ve been providing care through telemedicine for 6 years,” she said in an interview. Prior to COVID-19, her patients had gone to teleconsult centers for a telemedicine visit. With the onset of the COVID-19 pandemic, she expanded telehealth services to include more home video visits through the practice’s online medical record.

For care that can’t take place online, Dr. Peoples said she works with colleagues in orthopedics, which have far greater numbers than rheumatologists in Pennsylvania, to provide injections to patients. All of the teleconference centers are at local hospitals or outpatient community centers. Patients can go there to get an injection from another doctor, she said. Additionally, all of her practice’s locations at UPMC hospitals have infusion centers.
 

Adopting a ‘computer-side’ manner

Any practice offering telemedicine should be training their staff, as virtual meetings require certain skills, Dr. Peoples stressed. “You have to have experience as a rheumatologist, but you also have to have experience in telemedicine. Then it’s about merging those two skills.” Physicians need to be familiar with the technology and equipment. “I have a Bluetooth stethoscope that hears the heart and the lungs” of a patient during a virtual visit, she said.

Most importantly, physicians need to adopt a “computer-side” manner. “Make sure you have good eye contact on the screen, that you’re maintaining a good, professional relationship with the patient.” Training nurses to assist doctors during a telehealth visit is also key.

Dr. Peoples said UPMC has been training its fellows in telemedicine to adopt these skills.
 

Efforts to pay doctors for telehealth

As rheumatologists navigate the growing market for telehealth, questions remain about the long term payment outlook for these services.

For now, there appears to be reimbursement parity for telehealth visits, Dr. Feldman said. COVID-19’s public health emergency put into place certain flexibilities for telehealth. But some concerns remain about the commercial insurance sector. Whether private payers will continue paying the same amount as they do for in-person visits once the pandemic is over is unknown, Dr. Feldman added. “Insurance companies have had a boom in profits and should not be able to use ‘losses’ from COVID as an excuse for stopping pay parity for telehealth visits.”

David Allen, spokesperson for America’s Health Insurance Plans, said some plans are voluntarily offering telehealth payment parity during the public health emergency. “However, as a policy, AHIP does not support mandating that clinicians be paid the same amount for telehealth and in-person care,” Mr. Allen said, adding that AHIP hasn’t tallied how many insurance companies offer payment parity. “Too many variances exist between plans to make any kind of declarative statement on this.”

For her telemedicine visits at teleconsult centers, Dr. Peoples said compensation is comparable with traditional in-person visits. “Compensation is different for video visits where the patient is at home. However, these video visits are still reimbursed by most insurance plans.”

Federal payers and many states have taken actions on parity. Telehealth is seeing major legislative action at the state level, Kelly Hughes, a program director for the National Conference of State Legislatures, said during the CSRO meeting. All 50 states, the District of Columbia, and Puerto Rico have made revisions to telehealth policies during the COVID-19 pandemic to maintain access to health care services and to minimize potential exposure. Most of these are temporary modifications to address the pandemic, but some states are either adopting permanent changes or mulling over permanent changes to telehealth, Ms. Hughes said.

Modifications vary widely by state, but the top three trends include allowing reimbursement for phone calls (not requiring video), expanding the types of providers authorized to provide telehealth services, and allowing a relationship between a patient and provider to begin with a telehealth visit.

The Commonwealth Fund reports that at least 13 states have enacted payment parity laws in response to COVID-19. Another four had parity laws in place prior to the pandemic. “Many states have taken direct action via Medicaid policy; all but two issued specific guidance on the expansion or reimbursement of Medicaid-based telehealth services,” according to the Commonwealth Fund.

In Texas, where Dr. Monga practices. Gov. Greg Abbott (R) has temporarily waived regulations to lift certain telehealth restrictions. The Texas Department of Insurance under an emergency rule is directing state-regulated health plans to cover telemedicine visits at the same rate as in-person visits during the COVID-19 emergency declaration. “This has helped expand our telehealth options in Texas,” Dr. Monga said.

Medicare has also boosted coverage of telehealth services. “I appreciate that the Centers for Medicare & Medicaid Services has acknowledged the value of telehealth services by reimbursing for audio-only visits at the same rate as audiovisual and in-person evaluations during the public health emergency,” Dr. Monga said.

CMS has also proposed to expand telehealth access in its CY 2021 Physician Fee Schedule Proposed Rule. Additionally, the Department of Health & Human Services Office of Rights will not be penalizing physicians for HIPAA noncompliance for conducting visits through technologies such as FaceTime or Skype during COVID-19, she added.

While telehealth can’t replace all in-person visits in rheumatology, “it can certainly provide us with support during certain circumstances, as we have learned during the current health emergency,” Dr. Monga said. “I hope that even after this crisis has passed that parity for telehealth will be maintained and we can make permanent some of the current updates.”

Rheumatologists are seeing the number of telehealth visits skyrocket in their practices as the COVID-19 pandemic rages on and patients seek out alternatives to in-person visits. Telemedicine makes it easier for patients to connect with physicians, but not all patients have access to a computer or device. It also limits what a physician can do. Rheumatologists often rely on physical exams to make diagnoses and treatment decisions – an obstacle if you’re looking at patients through a computer screen.

FatCamera/E+

Presenters at the 2020 Coalition of State Rheumatology Organizations’ state advocacy conference discussed the benefits and challenges of this mode of care in early September. Within weeks, the U.S. health system eliminated almost half of all medical care as the pandemic ramped up and things went virtual, said Larry Van Horn, PhD, MPH, a speaker at the CSRO conference. Still, “we are in uncharted territory with respect to how telehealth is being used. ... It’s being deployed everywhere, but it’s too early to tell how it’s affecting patient outcomes,” said Dr. Van Horn, founder and director of the Center of Health Care Market Innovation at Vanderbilt University, Nashville, Tenn.

Patients seem to like using telemedicine, observed New Jersey state Sen. Herb Conaway, MD, another presenter. “I think it’s here to stay, and it’s likely to expand going forward. But physicians and others are going to want to make sure it’s used appropriately.”

Some payers feel that telemedicine should be billed differently than brick and mortar visits, Dr. Conaway said. “Physicians feel differently about that, and so we’ll see how this goes, moving forward.”

Lately, there have been discussions of liability concerns associated with telemedicine, said CSRO President Madelaine A. Feldman, MD, who practices in New Orleans. “There are some things you can miss with virtual visits. Certain new patient visits may need to be done in person.”
 

The landscape of telehealth in rheumatology

Telehealth has directly affected the way rheumatologists do business. In a national survey of more than 1,100 adult patients, the American College of Rheumatology found that 66% are choosing telehealth for rheumatology visits, mainly to avoid exposure to the SARS-CoV-2 virus. This contrasts with a 52% decline in the percentage of patients who are currently seeing a rheumatologist since 2019. “The pandemic has altered almost every aspect of our rheumatology practices,” said ACR President Ellen Gravallese, MD in a statement. “It has impacted our patients’ lives significantly and required us to create new ways of delivering care through improved telehealth and other adaptations.”

While many rheumatologists have resumed in-person visits, “others, like myself, are doing a hybrid,” Dr. Feldman said.

At the height of the pandemic in New York City, Elana J. Bernstein, MD’s practice relied entirely on telehealth visits. “We weren’t seeing any patients in the office for a couple of months. Now that things have reopened here, we’ve resumed face-to-face visits,” keeping some telehealth visits for patients who are still uncomfortable with in-person visits or who live far away, Dr. Bernstein, director of the scleroderma program at Columbia University, New York, said in an interview. She estimates that telehealth represents about 20%-30% of her practice right now.
 

Advantages, drawbacks of telehealth

For patients in underserved or geographically distant areas, telehealth means access to care, Kanika Monga, MD, of the University of Texas Health Science Center, Houston, said in an interview. During the COVID-19 public health crisis, “it has allowed the most vulnerable patient populations to continue receiving care at the click of a button.”

Virtual visits also improve patient care by improving follow-up and compliance, Dr. Monga continued. “For example, in our patient population, mobility can be a major issue because of the underlying disease. Telemedicine improves care for patients who struggle to make it to appointments.” It’s also more convenient for patients in her county that depend on arranged and/or public transportation and have to request a portion of their day off work for a doctor’s appointment.

But the virtual visit has its drawbacks. Different available platforms and their usability create challenges, Dr. Monga said. “Although some patients are tech-savvy, some are not. This is a challenge, especially when using platforms that have many steps involved.” Telemedicine also highlights general health inequities that already exist in some populations. Patients who are older, live in rural areas, are less educated, or are from a lower socioeconomic household might not have the technology or Internet connection available to enable telemedicine visits.

Telemedicine also complicates the physical examination, which is a central part of the diagnostic process, Dr. Bernstein said. Some components of the physical exam lend themselves to a video visit, such as evaluating for facial rashes or examining a patient’s digital ulcers. “But if you suspect the patient has rheumatoid arthritis, for example, you can’t examine the joints for swelling.” When seeing scleroderma patients over telemedicine, “I can’t perform the modified Rodnan skin score to assess for skin thickening, or auscultate the lungs for crackles. It’s also hard to assess a patient’s response to therapy over telemedicine,” Dr. Feldman added.

Some rheumatologists have sought out multiple pathways on telemedicine to provide more options for patients.

Christine Peoples, MD, clinical assistant professor of medicine at the University of Pittsburgh Medical Center, uses several telehealth options to reach patients that live in the largely rural area she serves. For her, telemedicine isn’t a novel concept. “I’ve been providing care through telemedicine for 6 years,” she said in an interview. Prior to COVID-19, her patients had gone to teleconsult centers for a telemedicine visit. With the onset of the COVID-19 pandemic, she expanded telehealth services to include more home video visits through the practice’s online medical record.

For care that can’t take place online, Dr. Peoples said she works with colleagues in orthopedics, which have far greater numbers than rheumatologists in Pennsylvania, to provide injections to patients. All of the teleconference centers are at local hospitals or outpatient community centers. Patients can go there to get an injection from another doctor, she said. Additionally, all of her practice’s locations at UPMC hospitals have infusion centers.
 

Adopting a ‘computer-side’ manner

Any practice offering telemedicine should be training their staff, as virtual meetings require certain skills, Dr. Peoples stressed. “You have to have experience as a rheumatologist, but you also have to have experience in telemedicine. Then it’s about merging those two skills.” Physicians need to be familiar with the technology and equipment. “I have a Bluetooth stethoscope that hears the heart and the lungs” of a patient during a virtual visit, she said.

Most importantly, physicians need to adopt a “computer-side” manner. “Make sure you have good eye contact on the screen, that you’re maintaining a good, professional relationship with the patient.” Training nurses to assist doctors during a telehealth visit is also key.

Dr. Peoples said UPMC has been training its fellows in telemedicine to adopt these skills.
 

Efforts to pay doctors for telehealth

As rheumatologists navigate the growing market for telehealth, questions remain about the long term payment outlook for these services.

For now, there appears to be reimbursement parity for telehealth visits, Dr. Feldman said. COVID-19’s public health emergency put into place certain flexibilities for telehealth. But some concerns remain about the commercial insurance sector. Whether private payers will continue paying the same amount as they do for in-person visits once the pandemic is over is unknown, Dr. Feldman added. “Insurance companies have had a boom in profits and should not be able to use ‘losses’ from COVID as an excuse for stopping pay parity for telehealth visits.”

David Allen, spokesperson for America’s Health Insurance Plans, said some plans are voluntarily offering telehealth payment parity during the public health emergency. “However, as a policy, AHIP does not support mandating that clinicians be paid the same amount for telehealth and in-person care,” Mr. Allen said, adding that AHIP hasn’t tallied how many insurance companies offer payment parity. “Too many variances exist between plans to make any kind of declarative statement on this.”

For her telemedicine visits at teleconsult centers, Dr. Peoples said compensation is comparable with traditional in-person visits. “Compensation is different for video visits where the patient is at home. However, these video visits are still reimbursed by most insurance plans.”

Federal payers and many states have taken actions on parity. Telehealth is seeing major legislative action at the state level, Kelly Hughes, a program director for the National Conference of State Legislatures, said during the CSRO meeting. All 50 states, the District of Columbia, and Puerto Rico have made revisions to telehealth policies during the COVID-19 pandemic to maintain access to health care services and to minimize potential exposure. Most of these are temporary modifications to address the pandemic, but some states are either adopting permanent changes or mulling over permanent changes to telehealth, Ms. Hughes said.

Modifications vary widely by state, but the top three trends include allowing reimbursement for phone calls (not requiring video), expanding the types of providers authorized to provide telehealth services, and allowing a relationship between a patient and provider to begin with a telehealth visit.

The Commonwealth Fund reports that at least 13 states have enacted payment parity laws in response to COVID-19. Another four had parity laws in place prior to the pandemic. “Many states have taken direct action via Medicaid policy; all but two issued specific guidance on the expansion or reimbursement of Medicaid-based telehealth services,” according to the Commonwealth Fund.

In Texas, where Dr. Monga practices. Gov. Greg Abbott (R) has temporarily waived regulations to lift certain telehealth restrictions. The Texas Department of Insurance under an emergency rule is directing state-regulated health plans to cover telemedicine visits at the same rate as in-person visits during the COVID-19 emergency declaration. “This has helped expand our telehealth options in Texas,” Dr. Monga said.

Medicare has also boosted coverage of telehealth services. “I appreciate that the Centers for Medicare & Medicaid Services has acknowledged the value of telehealth services by reimbursing for audio-only visits at the same rate as audiovisual and in-person evaluations during the public health emergency,” Dr. Monga said.

CMS has also proposed to expand telehealth access in its CY 2021 Physician Fee Schedule Proposed Rule. Additionally, the Department of Health & Human Services Office of Rights will not be penalizing physicians for HIPAA noncompliance for conducting visits through technologies such as FaceTime or Skype during COVID-19, she added.

While telehealth can’t replace all in-person visits in rheumatology, “it can certainly provide us with support during certain circumstances, as we have learned during the current health emergency,” Dr. Monga said. “I hope that even after this crisis has passed that parity for telehealth will be maintained and we can make permanent some of the current updates.”

Rheumatologists are seeing the number of telehealth visits skyrocket in their practices as the COVID-19 pandemic rages on and patients seek out alternatives to in-person visits. Telemedicine makes it easier for patients to connect with physicians, but not all patients have access to a computer or device. It also limits what a physician can do. Rheumatologists often rely on physical exams to make diagnoses and treatment decisions – an obstacle if you’re looking at patients through a computer screen.

FatCamera/E+

Presenters at the 2020 Coalition of State Rheumatology Organizations’ state advocacy conference discussed the benefits and challenges of this mode of care in early September. Within weeks, the U.S. health system eliminated almost half of all medical care as the pandemic ramped up and things went virtual, said Larry Van Horn, PhD, MPH, a speaker at the CSRO conference. Still, “we are in uncharted territory with respect to how telehealth is being used. ... It’s being deployed everywhere, but it’s too early to tell how it’s affecting patient outcomes,” said Dr. Van Horn, founder and director of the Center of Health Care Market Innovation at Vanderbilt University, Nashville, Tenn.

Patients seem to like using telemedicine, observed New Jersey state Sen. Herb Conaway, MD, another presenter. “I think it’s here to stay, and it’s likely to expand going forward. But physicians and others are going to want to make sure it’s used appropriately.”

Some payers feel that telemedicine should be billed differently than brick and mortar visits, Dr. Conaway said. “Physicians feel differently about that, and so we’ll see how this goes, moving forward.”

Lately, there have been discussions of liability concerns associated with telemedicine, said CSRO President Madelaine A. Feldman, MD, who practices in New Orleans. “There are some things you can miss with virtual visits. Certain new patient visits may need to be done in person.”
 

The landscape of telehealth in rheumatology

Telehealth has directly affected the way rheumatologists do business. In a national survey of more than 1,100 adult patients, the American College of Rheumatology found that 66% are choosing telehealth for rheumatology visits, mainly to avoid exposure to the SARS-CoV-2 virus. This contrasts with a 52% decline in the percentage of patients who are currently seeing a rheumatologist since 2019. “The pandemic has altered almost every aspect of our rheumatology practices,” said ACR President Ellen Gravallese, MD in a statement. “It has impacted our patients’ lives significantly and required us to create new ways of delivering care through improved telehealth and other adaptations.”

While many rheumatologists have resumed in-person visits, “others, like myself, are doing a hybrid,” Dr. Feldman said.

At the height of the pandemic in New York City, Elana J. Bernstein, MD’s practice relied entirely on telehealth visits. “We weren’t seeing any patients in the office for a couple of months. Now that things have reopened here, we’ve resumed face-to-face visits,” keeping some telehealth visits for patients who are still uncomfortable with in-person visits or who live far away, Dr. Bernstein, director of the scleroderma program at Columbia University, New York, said in an interview. She estimates that telehealth represents about 20%-30% of her practice right now.
 

Advantages, drawbacks of telehealth

For patients in underserved or geographically distant areas, telehealth means access to care, Kanika Monga, MD, of the University of Texas Health Science Center, Houston, said in an interview. During the COVID-19 public health crisis, “it has allowed the most vulnerable patient populations to continue receiving care at the click of a button.”

Virtual visits also improve patient care by improving follow-up and compliance, Dr. Monga continued. “For example, in our patient population, mobility can be a major issue because of the underlying disease. Telemedicine improves care for patients who struggle to make it to appointments.” It’s also more convenient for patients in her county that depend on arranged and/or public transportation and have to request a portion of their day off work for a doctor’s appointment.

But the virtual visit has its drawbacks. Different available platforms and their usability create challenges, Dr. Monga said. “Although some patients are tech-savvy, some are not. This is a challenge, especially when using platforms that have many steps involved.” Telemedicine also highlights general health inequities that already exist in some populations. Patients who are older, live in rural areas, are less educated, or are from a lower socioeconomic household might not have the technology or Internet connection available to enable telemedicine visits.

Telemedicine also complicates the physical examination, which is a central part of the diagnostic process, Dr. Bernstein said. Some components of the physical exam lend themselves to a video visit, such as evaluating for facial rashes or examining a patient’s digital ulcers. “But if you suspect the patient has rheumatoid arthritis, for example, you can’t examine the joints for swelling.” When seeing scleroderma patients over telemedicine, “I can’t perform the modified Rodnan skin score to assess for skin thickening, or auscultate the lungs for crackles. It’s also hard to assess a patient’s response to therapy over telemedicine,” Dr. Feldman added.

Some rheumatologists have sought out multiple pathways on telemedicine to provide more options for patients.

Christine Peoples, MD, clinical assistant professor of medicine at the University of Pittsburgh Medical Center, uses several telehealth options to reach patients that live in the largely rural area she serves. For her, telemedicine isn’t a novel concept. “I’ve been providing care through telemedicine for 6 years,” she said in an interview. Prior to COVID-19, her patients had gone to teleconsult centers for a telemedicine visit. With the onset of the COVID-19 pandemic, she expanded telehealth services to include more home video visits through the practice’s online medical record.

For care that can’t take place online, Dr. Peoples said she works with colleagues in orthopedics, which have far greater numbers than rheumatologists in Pennsylvania, to provide injections to patients. All of the teleconference centers are at local hospitals or outpatient community centers. Patients can go there to get an injection from another doctor, she said. Additionally, all of her practice’s locations at UPMC hospitals have infusion centers.
 

Adopting a ‘computer-side’ manner

Any practice offering telemedicine should be training their staff, as virtual meetings require certain skills, Dr. Peoples stressed. “You have to have experience as a rheumatologist, but you also have to have experience in telemedicine. Then it’s about merging those two skills.” Physicians need to be familiar with the technology and equipment. “I have a Bluetooth stethoscope that hears the heart and the lungs” of a patient during a virtual visit, she said.

Most importantly, physicians need to adopt a “computer-side” manner. “Make sure you have good eye contact on the screen, that you’re maintaining a good, professional relationship with the patient.” Training nurses to assist doctors during a telehealth visit is also key.

Dr. Peoples said UPMC has been training its fellows in telemedicine to adopt these skills.
 

Efforts to pay doctors for telehealth

As rheumatologists navigate the growing market for telehealth, questions remain about the long term payment outlook for these services.

For now, there appears to be reimbursement parity for telehealth visits, Dr. Feldman said. COVID-19’s public health emergency put into place certain flexibilities for telehealth. But some concerns remain about the commercial insurance sector. Whether private payers will continue paying the same amount as they do for in-person visits once the pandemic is over is unknown, Dr. Feldman added. “Insurance companies have had a boom in profits and should not be able to use ‘losses’ from COVID as an excuse for stopping pay parity for telehealth visits.”

David Allen, spokesperson for America’s Health Insurance Plans, said some plans are voluntarily offering telehealth payment parity during the public health emergency. “However, as a policy, AHIP does not support mandating that clinicians be paid the same amount for telehealth and in-person care,” Mr. Allen said, adding that AHIP hasn’t tallied how many insurance companies offer payment parity. “Too many variances exist between plans to make any kind of declarative statement on this.”

For her telemedicine visits at teleconsult centers, Dr. Peoples said compensation is comparable with traditional in-person visits. “Compensation is different for video visits where the patient is at home. However, these video visits are still reimbursed by most insurance plans.”

Federal payers and many states have taken actions on parity. Telehealth is seeing major legislative action at the state level, Kelly Hughes, a program director for the National Conference of State Legislatures, said during the CSRO meeting. All 50 states, the District of Columbia, and Puerto Rico have made revisions to telehealth policies during the COVID-19 pandemic to maintain access to health care services and to minimize potential exposure. Most of these are temporary modifications to address the pandemic, but some states are either adopting permanent changes or mulling over permanent changes to telehealth, Ms. Hughes said.

Modifications vary widely by state, but the top three trends include allowing reimbursement for phone calls (not requiring video), expanding the types of providers authorized to provide telehealth services, and allowing a relationship between a patient and provider to begin with a telehealth visit.

The Commonwealth Fund reports that at least 13 states have enacted payment parity laws in response to COVID-19. Another four had parity laws in place prior to the pandemic. “Many states have taken direct action via Medicaid policy; all but two issued specific guidance on the expansion or reimbursement of Medicaid-based telehealth services,” according to the Commonwealth Fund.

In Texas, where Dr. Monga practices. Gov. Greg Abbott (R) has temporarily waived regulations to lift certain telehealth restrictions. The Texas Department of Insurance under an emergency rule is directing state-regulated health plans to cover telemedicine visits at the same rate as in-person visits during the COVID-19 emergency declaration. “This has helped expand our telehealth options in Texas,” Dr. Monga said.

Medicare has also boosted coverage of telehealth services. “I appreciate that the Centers for Medicare & Medicaid Services has acknowledged the value of telehealth services by reimbursing for audio-only visits at the same rate as audiovisual and in-person evaluations during the public health emergency,” Dr. Monga said.

CMS has also proposed to expand telehealth access in its CY 2021 Physician Fee Schedule Proposed Rule. Additionally, the Department of Health & Human Services Office of Rights will not be penalizing physicians for HIPAA noncompliance for conducting visits through technologies such as FaceTime or Skype during COVID-19, she added.

While telehealth can’t replace all in-person visits in rheumatology, “it can certainly provide us with support during certain circumstances, as we have learned during the current health emergency,” Dr. Monga said. “I hope that even after this crisis has passed that parity for telehealth will be maintained and we can make permanent some of the current updates.”

Efficacy of immunotherapy also depends on breast cancer subtype. Triple-negative and HER2-positive tumors have higher TMB and TILs compared to luminal subtype. A phase 2 study in 88 patients with metastatic HR-positive, ERBB2-negative breast cancer demonstrated no difference in PFS or ORR with pembrolizumab/eribulin versus eribulin alone, including the PD-L1 positive population. There was a trend towards greater immunotherapy benefit in the high TMB subgroup which is encouraging. Future research with novel agents that may augment immune response and/or alter tumor microenvironment are intriguing concepts. 

First-line endocrine therapy plus CDK 4/6 inhibitor is considered standard of care for HR-positive metastatic breast cancer. A retrospective chart review evaluating everolimus plus endocrine therapy post-CDK 4/6 inhibitor demonstrated PFS of 4.2 months and ORR of 17%. Although benefit appears modest, mTOR inhibitor combinations remain a valuable treatment option for select patients. Chemotherapy is often reserved for rapidly progressive disease or visceral crisis, however, it is crucial to evaluate for endocrine resistance. Furthermore, additional research is warranted to determine interactions between PI3K/Akt/mTOR and downstream Cyclin D/CDK 4/6/Rb pathways and implications on treatment sequencing. 

Trastuzumab therapy for 1 year is standard of care for early-stage HER2-positive breast cancer. A meta-analysis of 5 trials with 11,376 patients showed noninferiority of shorter duration trastuzumab compared to 1 year for DFS and OS and lower congestive heart failure rates with the former. Trastuzumab is well-tolerated, and although cardiac toxicity is often reversible, it can carry more severe consequences in patients with cardiac conditions. Shorter duration may be an option in patients with clinically lower risk disease (ER-positive, node-negative tumors) and significant cardiac risk factors, and represents a method of therapy de-escalation for the appropriate patient.

The COVID-19 pandemic has impacted oncology healthcare delivery models and cancer patients have poorer outcomes from COVID-19. A survey study of Brazilian breast cancer specialists demonstrated changing practices for early-stage breast cancer as the pandemic progressed. For HR-positive tumors with low ki-67, 48% would recommend NET for postmenopausal women, while 34% would recommend NET for those with high ki-67. There is limited data regarding NET for pre-menopausal women. Genomic assays may have an evolving role to identify patients who may be appropriate candidates for neoadjuvant therapy versus upfront surgery. Strategies to decrease treatment complications and effectively utilize resources are essential during the COVID-19 pandemic. 

Erin Roesch, MD
The Cleveland Clinic

References:
Zhu L, Narloch, JL, Onkar S, et al. Metastatic breast cancers have reduced immune cell recruitment but harbor increased macrophages relative to their matched primary tumors. J Immunother Cancer 2019; 7:265. 

Nanda R, Liu MC, Yau C, et al. Effect of pembrolizumab plus neoadjuvant chemotherapy on pathologic complete response in women with early-stage breast cancer: An analysis of the ongoing phase 2 adaptively randomized I-SPY2 trial. JAMA Oncol. 2020; 6(5):676–684.

Schmid P, Adams S, Rugo HS, et al. IMpassion130: updated overall survival (OS) from a global, randomized, double-blind, placebo-controlled, Phase III study of atezolizumab (atezo) + nab-paclitaxel (nP) in previously untreated locally advanced or metastatic triple-negative breast cancer (mTNBC). J Clin Oncol 2019; 37S:ASCO #1003. 

Cortes J, Cescon DW, Rugo HS, et al. KEYNOTE-355: Randomized, double-blind, phase III study of pembrolizumab + chemotherapy versus placebo + chemotherapy for previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer. J Clin Oncol 2020;38S:ASCO #1000. 

Martinello R, Becco P, Vici P, et al. Trastuzumab-related cardiotoxicity in patients with nonlimiting cardiac comorbidity. Breast J 2019; 25(3):444-449.

Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol 2020; 21(3):335-337.

Efficacy of immunotherapy also depends on breast cancer subtype. Triple-negative and HER2-positive tumors have higher TMB and TILs compared to luminal subtype. A phase 2 study in 88 patients with metastatic HR-positive, ERBB2-negative breast cancer demonstrated no difference in PFS or ORR with pembrolizumab/eribulin versus eribulin alone, including the PD-L1 positive population. There was a trend towards greater immunotherapy benefit in the high TMB subgroup which is encouraging. Future research with novel agents that may augment immune response and/or alter tumor microenvironment are intriguing concepts. 

First-line endocrine therapy plus CDK 4/6 inhibitor is considered standard of care for HR-positive metastatic breast cancer. A retrospective chart review evaluating everolimus plus endocrine therapy post-CDK 4/6 inhibitor demonstrated PFS of 4.2 months and ORR of 17%. Although benefit appears modest, mTOR inhibitor combinations remain a valuable treatment option for select patients. Chemotherapy is often reserved for rapidly progressive disease or visceral crisis, however, it is crucial to evaluate for endocrine resistance. Furthermore, additional research is warranted to determine interactions between PI3K/Akt/mTOR and downstream Cyclin D/CDK 4/6/Rb pathways and implications on treatment sequencing. 

Trastuzumab therapy for 1 year is standard of care for early-stage HER2-positive breast cancer. A meta-analysis of 5 trials with 11,376 patients showed noninferiority of shorter duration trastuzumab compared to 1 year for DFS and OS and lower congestive heart failure rates with the former. Trastuzumab is well-tolerated, and although cardiac toxicity is often reversible, it can carry more severe consequences in patients with cardiac conditions. Shorter duration may be an option in patients with clinically lower risk disease (ER-positive, node-negative tumors) and significant cardiac risk factors, and represents a method of therapy de-escalation for the appropriate patient.

The COVID-19 pandemic has impacted oncology healthcare delivery models and cancer patients have poorer outcomes from COVID-19. A survey study of Brazilian breast cancer specialists demonstrated changing practices for early-stage breast cancer as the pandemic progressed. For HR-positive tumors with low ki-67, 48% would recommend NET for postmenopausal women, while 34% would recommend NET for those with high ki-67. There is limited data regarding NET for pre-menopausal women. Genomic assays may have an evolving role to identify patients who may be appropriate candidates for neoadjuvant therapy versus upfront surgery. Strategies to decrease treatment complications and effectively utilize resources are essential during the COVID-19 pandemic. 

Erin Roesch, MD
The Cleveland Clinic

References:
Zhu L, Narloch, JL, Onkar S, et al. Metastatic breast cancers have reduced immune cell recruitment but harbor increased macrophages relative to their matched primary tumors. J Immunother Cancer 2019; 7:265. 

Nanda R, Liu MC, Yau C, et al. Effect of pembrolizumab plus neoadjuvant chemotherapy on pathologic complete response in women with early-stage breast cancer: An analysis of the ongoing phase 2 adaptively randomized I-SPY2 trial. JAMA Oncol. 2020; 6(5):676–684.

Schmid P, Adams S, Rugo HS, et al. IMpassion130: updated overall survival (OS) from a global, randomized, double-blind, placebo-controlled, Phase III study of atezolizumab (atezo) + nab-paclitaxel (nP) in previously untreated locally advanced or metastatic triple-negative breast cancer (mTNBC). J Clin Oncol 2019; 37S:ASCO #1003. 

Cortes J, Cescon DW, Rugo HS, et al. KEYNOTE-355: Randomized, double-blind, phase III study of pembrolizumab + chemotherapy versus placebo + chemotherapy for previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer. J Clin Oncol 2020;38S:ASCO #1000. 

Martinello R, Becco P, Vici P, et al. Trastuzumab-related cardiotoxicity in patients with nonlimiting cardiac comorbidity. Breast J 2019; 25(3):444-449.

Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol 2020; 21(3):335-337.

Efficacy of immunotherapy also depends on breast cancer subtype. Triple-negative and HER2-positive tumors have higher TMB and TILs compared to luminal subtype. A phase 2 study in 88 patients with metastatic HR-positive, ERBB2-negative breast cancer demonstrated no difference in PFS or ORR with pembrolizumab/eribulin versus eribulin alone, including the PD-L1 positive population. There was a trend towards greater immunotherapy benefit in the high TMB subgroup which is encouraging. Future research with novel agents that may augment immune response and/or alter tumor microenvironment are intriguing concepts. 

First-line endocrine therapy plus CDK 4/6 inhibitor is considered standard of care for HR-positive metastatic breast cancer. A retrospective chart review evaluating everolimus plus endocrine therapy post-CDK 4/6 inhibitor demonstrated PFS of 4.2 months and ORR of 17%. Although benefit appears modest, mTOR inhibitor combinations remain a valuable treatment option for select patients. Chemotherapy is often reserved for rapidly progressive disease or visceral crisis, however, it is crucial to evaluate for endocrine resistance. Furthermore, additional research is warranted to determine interactions between PI3K/Akt/mTOR and downstream Cyclin D/CDK 4/6/Rb pathways and implications on treatment sequencing. 

Trastuzumab therapy for 1 year is standard of care for early-stage HER2-positive breast cancer. A meta-analysis of 5 trials with 11,376 patients showed noninferiority of shorter duration trastuzumab compared to 1 year for DFS and OS and lower congestive heart failure rates with the former. Trastuzumab is well-tolerated, and although cardiac toxicity is often reversible, it can carry more severe consequences in patients with cardiac conditions. Shorter duration may be an option in patients with clinically lower risk disease (ER-positive, node-negative tumors) and significant cardiac risk factors, and represents a method of therapy de-escalation for the appropriate patient.

The COVID-19 pandemic has impacted oncology healthcare delivery models and cancer patients have poorer outcomes from COVID-19. A survey study of Brazilian breast cancer specialists demonstrated changing practices for early-stage breast cancer as the pandemic progressed. For HR-positive tumors with low ki-67, 48% would recommend NET for postmenopausal women, while 34% would recommend NET for those with high ki-67. There is limited data regarding NET for pre-menopausal women. Genomic assays may have an evolving role to identify patients who may be appropriate candidates for neoadjuvant therapy versus upfront surgery. Strategies to decrease treatment complications and effectively utilize resources are essential during the COVID-19 pandemic. 

Erin Roesch, MD
The Cleveland Clinic

References:
Zhu L, Narloch, JL, Onkar S, et al. Metastatic breast cancers have reduced immune cell recruitment but harbor increased macrophages relative to their matched primary tumors. J Immunother Cancer 2019; 7:265. 

Nanda R, Liu MC, Yau C, et al. Effect of pembrolizumab plus neoadjuvant chemotherapy on pathologic complete response in women with early-stage breast cancer: An analysis of the ongoing phase 2 adaptively randomized I-SPY2 trial. JAMA Oncol. 2020; 6(5):676–684.

Schmid P, Adams S, Rugo HS, et al. IMpassion130: updated overall survival (OS) from a global, randomized, double-blind, placebo-controlled, Phase III study of atezolizumab (atezo) + nab-paclitaxel (nP) in previously untreated locally advanced or metastatic triple-negative breast cancer (mTNBC). J Clin Oncol 2019; 37S:ASCO #1003. 

Cortes J, Cescon DW, Rugo HS, et al. KEYNOTE-355: Randomized, double-blind, phase III study of pembrolizumab + chemotherapy versus placebo + chemotherapy for previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer. J Clin Oncol 2020;38S:ASCO #1000. 

Martinello R, Becco P, Vici P, et al. Trastuzumab-related cardiotoxicity in patients with nonlimiting cardiac comorbidity. Breast J 2019; 25(3):444-449.

Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol 2020; 21(3):335-337.

Key clinical point: Sarcoidosis can develop after breast cancer and requires histologic confirmation.

Major finding: Twenty of 429 (4.9%) women with sarcoidosis had breast cancer, which usually was diagnosed first. Sarcoidosis was diagnosed at a median age of 53.9 years, most often involved the lungs and central lymph nodes, and was asymptomatic in half of cases.

Study details: Single-center retrospective study of 1,000 sarcoidosis cases.

Disclosures: The study was not funded. The investigators reported having no conflicts.

Citation: Papanikolaou IC et al. Resp Med Case Rep. 2020 Aug 13.  doi: 10.1016/j.rmcr.2020.101190

Key clinical point: Sarcoidosis can develop after breast cancer and requires histologic confirmation.

Major finding: Twenty of 429 (4.9%) women with sarcoidosis had breast cancer, which usually was diagnosed first. Sarcoidosis was diagnosed at a median age of 53.9 years, most often involved the lungs and central lymph nodes, and was asymptomatic in half of cases.

Study details: Single-center retrospective study of 1,000 sarcoidosis cases.

Disclosures: The study was not funded. The investigators reported having no conflicts.

Citation: Papanikolaou IC et al. Resp Med Case Rep. 2020 Aug 13.  doi: 10.1016/j.rmcr.2020.101190

Key clinical point: Sarcoidosis can develop after breast cancer and requires histologic confirmation.

Major finding: Twenty of 429 (4.9%) women with sarcoidosis had breast cancer, which usually was diagnosed first. Sarcoidosis was diagnosed at a median age of 53.9 years, most often involved the lungs and central lymph nodes, and was asymptomatic in half of cases.

Study details: Single-center retrospective study of 1,000 sarcoidosis cases.

Disclosures: The study was not funded. The investigators reported having no conflicts.

Citation: Papanikolaou IC et al. Resp Med Case Rep. 2020 Aug 13.  doi: 10.1016/j.rmcr.2020.101190

Key clinical point: The mTOR inhibitor everolimus performed modestly when sequenced after palbociclib in metastatic HR+ HER2- breast cancer.

Major finding: Median PFS on everolimus was 4.2 months. ORR was 17.1% (all partial responses).

Study details: Two-center retrospective chart review of 41 patients who received everolimus combinations after their metastatic HR+ HER2- breast cancer progressed on palbociclib.

Disclosures: The National Cancer Institute provided funding. Four of the investigators disclosed ties to Novartis, Pfizer, and other pharmaceutical companies.

Citation: Dhakal A et al. Breast Cancer (Auckl). 2020 Jul 23. doi: 10.1177/1178223420944864

Key clinical point: The mTOR inhibitor everolimus performed modestly when sequenced after palbociclib in metastatic HR+ HER2- breast cancer.

Major finding: Median PFS on everolimus was 4.2 months. ORR was 17.1% (all partial responses).

Study details: Two-center retrospective chart review of 41 patients who received everolimus combinations after their metastatic HR+ HER2- breast cancer progressed on palbociclib.

Disclosures: The National Cancer Institute provided funding. Four of the investigators disclosed ties to Novartis, Pfizer, and other pharmaceutical companies.

Citation: Dhakal A et al. Breast Cancer (Auckl). 2020 Jul 23. doi: 10.1177/1178223420944864

Key clinical point: The mTOR inhibitor everolimus performed modestly when sequenced after palbociclib in metastatic HR+ HER2- breast cancer.

Major finding: Median PFS on everolimus was 4.2 months. ORR was 17.1% (all partial responses).

Study details: Two-center retrospective chart review of 41 patients who received everolimus combinations after their metastatic HR+ HER2- breast cancer progressed on palbociclib.

Disclosures: The National Cancer Institute provided funding. Four of the investigators disclosed ties to Novartis, Pfizer, and other pharmaceutical companies.

Citation: Dhakal A et al. Breast Cancer (Auckl). 2020 Jul 23. doi: 10.1177/1178223420944864

Key clinical point: In Brazil, the COVID-19 pandemic changed how specialists managed early breast cancer, especially HR-positive tumors.

Major finding: Nearly 70% of breast cancer specialists reported changing their management of early breast cancer. For more proliferative HR-positive tumors (Ki-67 >30%), 34% recommended neoadjuvant endocrine therapy (NET) for postmenopausal patients, while 10.9% recommended NET for premenopausal patients.

Study details: Survey of 503 breast cancer specialists in Brazil.

Disclosures: The study was not funded. The researchers reported having no conflicts.

Citation: Cavalcante FP et al. Breast Cancer Res Treat. 2020 Aug 16. doi: 10.1007/s10549-020-05877-y

Key clinical point: In Brazil, the COVID-19 pandemic changed how specialists managed early breast cancer, especially HR-positive tumors.

Major finding: Nearly 70% of breast cancer specialists reported changing their management of early breast cancer. For more proliferative HR-positive tumors (Ki-67 >30%), 34% recommended neoadjuvant endocrine therapy (NET) for postmenopausal patients, while 10.9% recommended NET for premenopausal patients.

Study details: Survey of 503 breast cancer specialists in Brazil.

Disclosures: The study was not funded. The researchers reported having no conflicts.

Citation: Cavalcante FP et al. Breast Cancer Res Treat. 2020 Aug 16. doi: 10.1007/s10549-020-05877-y

Key clinical point: In Brazil, the COVID-19 pandemic changed how specialists managed early breast cancer, especially HR-positive tumors.

Major finding: Nearly 70% of breast cancer specialists reported changing their management of early breast cancer. For more proliferative HR-positive tumors (Ki-67 >30%), 34% recommended neoadjuvant endocrine therapy (NET) for postmenopausal patients, while 10.9% recommended NET for premenopausal patients.

Study details: Survey of 503 breast cancer specialists in Brazil.

Disclosures: The study was not funded. The researchers reported having no conflicts.

Citation: Cavalcante FP et al. Breast Cancer Res Treat. 2020 Aug 16. doi: 10.1007/s10549-020-05877-y

Key clinical point: For patients with early breast cancer, ≤ 6 months of adjuvant trastuzumab was noninferior to a 1-year course and appeared to be less cardiotoxic.

Major finding: 5-year DFS rates were 85.4% vs. 87.1%, respectively. Rates of congestive heart failure were 3.9% vs. 6.9%, respectively.

Study details: Meta-analysis of 5 randomized trials (11,376 patients).

Disclosures: Funding sources were not reported. Two coinvestigators disclosed ties to Roche, Eisai, Novartis, Sanofi, Kendle India, and several other pharmaceutical companies.

Citation: Gulia S et al. 2020 Aug 24. JAMA Netw Open. doi: 10.1001/jamanetworkopen.2020.11777

Key clinical point: For patients with early breast cancer, ≤ 6 months of adjuvant trastuzumab was noninferior to a 1-year course and appeared to be less cardiotoxic.

Major finding: 5-year DFS rates were 85.4% vs. 87.1%, respectively. Rates of congestive heart failure were 3.9% vs. 6.9%, respectively.

Study details: Meta-analysis of 5 randomized trials (11,376 patients).

Disclosures: Funding sources were not reported. Two coinvestigators disclosed ties to Roche, Eisai, Novartis, Sanofi, Kendle India, and several other pharmaceutical companies.

Citation: Gulia S et al. 2020 Aug 24. JAMA Netw Open. doi: 10.1001/jamanetworkopen.2020.11777

Key clinical point: For patients with early breast cancer, ≤ 6 months of adjuvant trastuzumab was noninferior to a 1-year course and appeared to be less cardiotoxic.

Major finding: 5-year DFS rates were 85.4% vs. 87.1%, respectively. Rates of congestive heart failure were 3.9% vs. 6.9%, respectively.

Study details: Meta-analysis of 5 randomized trials (11,376 patients).

Disclosures: Funding sources were not reported. Two coinvestigators disclosed ties to Roche, Eisai, Novartis, Sanofi, Kendle India, and several other pharmaceutical companies.

Citation: Gulia S et al. 2020 Aug 24. JAMA Netw Open. doi: 10.1001/jamanetworkopen.2020.11777

Key clinical point: Despite showing efficacy in specific subgroups, immune checkpoint inhibitors (ICIs) are unlikely to benefit most women with metastatic breast cancer.

Major finding: Objective response rates were 19% overall, 27% in PD-L1 positive patients, 18% in PD-L1 negative patients, 28% in HER2-positive breast cancer, 23% in triple-negative breast cancer, 35% when used in the first line, 26% when combined with systemic therapy, and 9% when used as monotherapy.

Study details: Meta-analysis of 27 studies of metastatic breast cancer (1,746 patients).

Disclosures: The study was funded by the National Natural Science Foundation of China. The investigators reported having no conflicts.

Citation: Zou Y et al. Ther Adv Med Oncol. 2020 Aug 17. doi: 10.1177/1758835920940928

Key clinical point: Despite showing efficacy in specific subgroups, immune checkpoint inhibitors (ICIs) are unlikely to benefit most women with metastatic breast cancer.

Major finding: Objective response rates were 19% overall, 27% in PD-L1 positive patients, 18% in PD-L1 negative patients, 28% in HER2-positive breast cancer, 23% in triple-negative breast cancer, 35% when used in the first line, 26% when combined with systemic therapy, and 9% when used as monotherapy.

Study details: Meta-analysis of 27 studies of metastatic breast cancer (1,746 patients).

Disclosures: The study was funded by the National Natural Science Foundation of China. The investigators reported having no conflicts.

Citation: Zou Y et al. Ther Adv Med Oncol. 2020 Aug 17. doi: 10.1177/1758835920940928

Key clinical point: Despite showing efficacy in specific subgroups, immune checkpoint inhibitors (ICIs) are unlikely to benefit most women with metastatic breast cancer.

Major finding: Objective response rates were 19% overall, 27% in PD-L1 positive patients, 18% in PD-L1 negative patients, 28% in HER2-positive breast cancer, 23% in triple-negative breast cancer, 35% when used in the first line, 26% when combined with systemic therapy, and 9% when used as monotherapy.

Study details: Meta-analysis of 27 studies of metastatic breast cancer (1,746 patients).

Disclosures: The study was funded by the National Natural Science Foundation of China. The investigators reported having no conflicts.

Citation: Zou Y et al. Ther Adv Med Oncol. 2020 Aug 17. doi: 10.1177/1758835920940928

Key clinical point: Later uptake and less extensive use of screening mammography might explain a relatively high rate of deaths from breast cancer among older women in Germany.

Major finding: Women aged ≥ 70 years in Germany had a 19% lower incidence but a 45% higher rate of mortality from breast cancer compared with their peers in the United States.

Study details: Population-based study of the Surveillance, Epidemiology, and End Results (SEER) 9 registry in the United States, and the Saarland Cancer Registry and the German Centre for Cancer Registry Data in Germany. 

Disclosures: German Cancer Aid funded the study. The investigators reported having no conflicts.

Citation: Jansen L et al. Cancers (Basel). 2020 Aug 26. doi: 10.3390/cancers12092419

Key clinical point: Later uptake and less extensive use of screening mammography might explain a relatively high rate of deaths from breast cancer among older women in Germany.

Major finding: Women aged ≥ 70 years in Germany had a 19% lower incidence but a 45% higher rate of mortality from breast cancer compared with their peers in the United States.

Study details: Population-based study of the Surveillance, Epidemiology, and End Results (SEER) 9 registry in the United States, and the Saarland Cancer Registry and the German Centre for Cancer Registry Data in Germany. 

Disclosures: German Cancer Aid funded the study. The investigators reported having no conflicts.

Citation: Jansen L et al. Cancers (Basel). 2020 Aug 26. doi: 10.3390/cancers12092419

Key clinical point: Later uptake and less extensive use of screening mammography might explain a relatively high rate of deaths from breast cancer among older women in Germany.

Major finding: Women aged ≥ 70 years in Germany had a 19% lower incidence but a 45% higher rate of mortality from breast cancer compared with their peers in the United States.

Study details: Population-based study of the Surveillance, Epidemiology, and End Results (SEER) 9 registry in the United States, and the Saarland Cancer Registry and the German Centre for Cancer Registry Data in Germany. 

Disclosures: German Cancer Aid funded the study. The investigators reported having no conflicts.

Citation: Jansen L et al. Cancers (Basel). 2020 Aug 26. doi: 10.3390/cancers12092419

Key clinical point: Prior use of conjugated equine estrogen in women who had a hysterectomy was associated with lower breast cancer incidence and mortality.

Major finding: Conjugated equine estrogen alone was associated with lower mortality (30 deaths, annualized mortality rate 0.031%), compared with placebo (46 deaths, annualized mortality rate 0.046%); HR 0.60; 95% CI, 0.37-0.97; P = .04.

Study details: This was a long-term follow-up study of two Women’s Health Initiative clinical trials of postmenopausal women with no prior breast cancer.

Disclosures: The Women’s Health Initiative is supported by the National Heart, Lung, and Blood Institute, the National Institutes of Health, and the Department of Health and Human Services. The authors reported numerous potential conflicts of interest, including receiving personal fees and grants from various government organizations, foundations, and pharmaceutical companies.

Citation: Chlebowski RT et al. JAMA. 2020 Jul 28. doi: 10.1001/jama.2020.9482.

Key clinical point: Prior use of conjugated equine estrogen in women who had a hysterectomy was associated with lower breast cancer incidence and mortality.

Major finding: Conjugated equine estrogen alone was associated with lower mortality (30 deaths, annualized mortality rate 0.031%), compared with placebo (46 deaths, annualized mortality rate 0.046%); HR 0.60; 95% CI, 0.37-0.97; P = .04.

Study details: This was a long-term follow-up study of two Women’s Health Initiative clinical trials of postmenopausal women with no prior breast cancer.

Disclosures: The Women’s Health Initiative is supported by the National Heart, Lung, and Blood Institute, the National Institutes of Health, and the Department of Health and Human Services. The authors reported numerous potential conflicts of interest, including receiving personal fees and grants from various government organizations, foundations, and pharmaceutical companies.

Citation: Chlebowski RT et al. JAMA. 2020 Jul 28. doi: 10.1001/jama.2020.9482.

Key clinical point: Prior use of conjugated equine estrogen in women who had a hysterectomy was associated with lower breast cancer incidence and mortality.

Major finding: Conjugated equine estrogen alone was associated with lower mortality (30 deaths, annualized mortality rate 0.031%), compared with placebo (46 deaths, annualized mortality rate 0.046%); HR 0.60; 95% CI, 0.37-0.97; P = .04.

Study details: This was a long-term follow-up study of two Women’s Health Initiative clinical trials of postmenopausal women with no prior breast cancer.

Disclosures: The Women’s Health Initiative is supported by the National Heart, Lung, and Blood Institute, the National Institutes of Health, and the Department of Health and Human Services. The authors reported numerous potential conflicts of interest, including receiving personal fees and grants from various government organizations, foundations, and pharmaceutical companies.

Citation: Chlebowski RT et al. JAMA. 2020 Jul 28. doi: 10.1001/jama.2020.9482.

Key clinical point: An automated image cytometry system called CytoPAN provides rapid cancer profiling and requires “scant” cellular specimens, according to researchers.

Major finding: In preclinical experiments, CytoPAN detected cancer in 1 hour using as few as 50 cells. In a patient cohort, CytoPAN detected breast cancer with 100% accuracy.

Study details: Preclinical research and a prospective study of 68 breast cancer patients.

Disclosures: The authors received funding from the National Institutes of Health, the MGH Scholar Fund, and Robert Wood Johnson Foundation. Some authors disclosed relationships with Akili, Accure Health, ModeRNA, Tarveda, Lumicell, and Noul.

Citation: Min J et al. Sci Transl Med. 2020 Aug 5. doi: 10.1126/scitranslmed.aaz9746.

Key clinical point: An automated image cytometry system called CytoPAN provides rapid cancer profiling and requires “scant” cellular specimens, according to researchers.

Major finding: In preclinical experiments, CytoPAN detected cancer in 1 hour using as few as 50 cells. In a patient cohort, CytoPAN detected breast cancer with 100% accuracy.

Study details: Preclinical research and a prospective study of 68 breast cancer patients.

Disclosures: The authors received funding from the National Institutes of Health, the MGH Scholar Fund, and Robert Wood Johnson Foundation. Some authors disclosed relationships with Akili, Accure Health, ModeRNA, Tarveda, Lumicell, and Noul.

Citation: Min J et al. Sci Transl Med. 2020 Aug 5. doi: 10.1126/scitranslmed.aaz9746.

Key clinical point: An automated image cytometry system called CytoPAN provides rapid cancer profiling and requires “scant” cellular specimens, according to researchers.

Major finding: In preclinical experiments, CytoPAN detected cancer in 1 hour using as few as 50 cells. In a patient cohort, CytoPAN detected breast cancer with 100% accuracy.

Study details: Preclinical research and a prospective study of 68 breast cancer patients.

Disclosures: The authors received funding from the National Institutes of Health, the MGH Scholar Fund, and Robert Wood Johnson Foundation. Some authors disclosed relationships with Akili, Accure Health, ModeRNA, Tarveda, Lumicell, and Noul.

Citation: Min J et al. Sci Transl Med. 2020 Aug 5. doi: 10.1126/scitranslmed.aaz9746.