Background
Conducted as part of WP4 (Sustainability) of the eCAN Joint Action, the aim of this foresight exercise was to understand how telemedicine services in EU-Member States (MS) could be implemented in a patient-centric way to tackle cancer.

Methods
Based on a literature review, we identified factors that impact on the implementation of telemedicine in EU MS; these were integrated to an online survey. Health policy experts were invited to rank 34 factors using a 7-point Likert scale to better understand the barriers and facilitators of telemedicine services at the health system level, whilst patient associations ranked 28 other factors to capture end-users’ view. Next, survey respondents were invited to a foresight workshop to collect qualitative data and gain a forward-looking perspective.

Results
20 health policy experts working in digital health across 14 EU MS, predominantly from Ministries of Health, and 8 cancer patient associations from 5 EU MS responded to the surveys. For a sustainable integration of telemedicine services in the EU, policy experts recommend developing a clear legal framework, embracing a hybrid healthcare model, and enhancing digital literacy. They stress the importance of telemedicine as a complementary tool, advocating for solid IT infrastructure, privacy safeguards, and the integration of health equity. Similarly, cancer patients emphasise the importance of being able to choose between telemedicine and in-person visits, focusing on personal interaction. They advocate for the involvement of patients in the design and testing of telemedicine services, ensuring solutions meet their preferences.

Conclusions
Policy experts and patients are in favour of hybrid models for cancer care. Recommended public health actions include: i) develop legal frameworks to complement in-person care with telemedicine; ii) boost digital literacy and IT infrastructure, ensuring privacy and health equity; and iii) involve patients in design for tailored services.

Key messages
• Both the EU Member States and cancer patients view telemedicine as a useful and complementary tool, however, not as a replacement for in-person healthcare services.

• Both the EU Member States and cancer patients champion telemedicine with a focus on equity, privacy, digital literacy and a hybrid model of care that respects patient preferences for cancer treatment.