Substantial racial disparities observed in use of telehealth by patients with cancer
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Black and Hispanic patients with cancer appeared less likely than white patients to use telehealth during the COVID-19 pandemic, according to an analysis of New York City health system data presented during ASCO Quality Care Symposium.
The results are important because telehealth will continue to be integrated into oncologic care, especially if another wave of COVID-19 infections occurs this winter, researchers noted.
“Telemedicine is one modality that is useful to mitigate disruptions to patient care, like what we saw during the height of the COVID-19 pandemic in New York City,” Cardinale B. Smith, MD, PhD, associate professor of medicine at Icahn School of Medicine at Mount Sinai, chief quality officer for cancer services in the Mount Sinai Health System and a member of Healio’s Women in Oncology Peer Perspective Board, said during a presentation. “The question is, how accessible is this form of care to minority populations?”
New York City became the epicenter of the COVID-19 pandemic, with efforts to “flatten the curve” leading to an abrupt stop to many services in the health care industry, including some oncologic care, according to study background.
Smith and Aarti Sonia Bhardwaj, MD, assistant professor in the division of hematology and oncology at Icahn School of Medicine at Mount Sinai, used electronic medical records to gather data on patients with cancer in the Mount Sinai Health System who had an in-person appointment or telehealth appointment during the peak of the pandemic between March 1 and June 1. The Mount Sinai system includes an NCI-designated cancer center and eight ambulatory sites across New York City.
Telehealth appointments included those conducted over the telephone as well as video visits.
Researchers used analysis of variance and the chi-square test to identify differences among the racial and ethnic groups regarding use and type of telehealth and compared any differences with baseline cancer center demographics.
Results showed 7,681 visits conducted via telehealth between March 1 and June 1, including 76% by video and 24% by telephone. Fewer than 1% of all patient visits last year were conducted via telehealth.
Among all patients seen within the health system in 2019, 42% were white, 23% were Black, 14% were Hispanic and 7% were Asian. The demographic breakdown of those who used telehealth during the study period was 48% white, 19% Black, 6% Hispanic, 7% Asian and 20% listed as other.
Half of patients who used telehealth for video visits were white (50%), whereas 17% were Black, 8% were Asian and 5% were Hispanic. The breakdown for telephone encounters was 43% white, 23% Black, 7% Hispanic and 6% Asian.
Overall, the data showed significantly fewer Black and Hispanic patients used telehealth as a whole (P = .02), video visits (P = .003) and phone visits (P = .02) than the total patient population.
The researchers are exploring ways to improve patient access to telehealth with a grant that will allow them to provide in-home remote patient monitoring, according to the press release. Patients will be provided with a Wi-Fi booster or enabler and a tablet to have video visits with their clinician and participate in patient-reported outcome measures.
“Telehealth utilization increased exponentially when we couldn’t provide care in person,” Smith said. “However, we observed a significant decrease in the amount of use of video visits in minority communities. The awareness of these disparities is critically important, especially now as other cities deal with outbreaks and because, in New York, we may have a second or third surge in cases.”
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Smith CB and Bhardwaj AS. Abstract 87. Presented at: 2020 ASCO Quality Care Symposium (virtual); Oct. 9-10, 2020.
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