Telemedicine in cancer care: lessons from COVID-19 and solutions for Europe.

The COVID-19 pandemic challenged healthcare delivery, especially cancer care. Telemedicine emerged as an important tool to reduce disease transmission risks, maintain continuity of care, and improve accessibility. This study explores temporary measures during the pandemic as well as challenges and facilitators for integrating telemedicine into the European healthcare landscape in five case countries, focusing on cancer care. Expert interviews were conducted in five EU countries with diverse health systems: Austria, Belgium, Denmark, Italy, and Poland. A thematic analysis was performed. Themes were further explored related to regulatory changes during COVID-19 as well as barriers and facilitators to telemedicine implementation. COVID-19 accelerated telemedicine uptake and processes (i.e. regulations, reimbursement) in all case countries. Acceptance of telemedicine increased among healthcare professionals and patients. Post-pandemic telemedicine use and acceptance declined to pre-pandemic levels in some countries and was attributed to several factors including preferences for in-person visits. Overall, persistent barriers were identified by all country experts including lack of standardized policies, data privacy concerns, technological infrastructure issues, and digital literacy gaps. Telemedicine was validated by all country experts as an important tool to enhance cancer care access and efficiency and to help maintaining continuity of cancer care during crises. Our findings highlight some overlapping barriers and suggest solutions to overcome these barriers across the selected countries. Recommendations for policymakers are listed, emphasizing the importance of telemedicine services in improving healthcare access, efficiency, and resilience. Future research should incorporate diverse population studies, patient perspectives, cost-effectiveness, and policy impacts.