Inequities observed in telemedicine use for cancer care during COVID-19 pandemic
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As telemedicine use increased during the COVID-19 pandemic, Black patients with cancer had lower usage levels than white patients, according to study results presented during a virtual press briefing ahead of the ASCO Annual Meeting.
Uninsured patients and those who lived in suburban or rural areas and resided in low-socioeconomic status neighborhoods also had a lower likelihood of telemedicine use, researchers noted.
Rationale and methods
“Telemedicine has the potential to enhance cancer care by increasing accessibility to cancer visits — including outreach to patients who live far away from clinic — and as a more accessible option requiring less time and travel,” Jenny S. Guadamuz, PhD, a quantitative scientist at Flatiron Health, told Healio.
Guadamuz and colleagues pooled data on 26,788 adults who initiated first-line cancer treatment at community-based cancer centers between March 2020 and November 2021, with follow-up through March 2022. They assessed differences in the number of telemedicine visits across race/ethnicity, insurance coverage, rural vs. suburban vs. urban residence and neighborhood socioeconomic status.
Telemedicine use served as the primary outcome.
Key findings
Results showed 15.9% of all patients used telemedicine services within 90 days after initiation of cancer treatment.
However, researchers observed significant disparities in use. Specifically, a lower percentage of Black patients used telemedicine services compared with their white counterparts (13.2% vs. 15.6%). Moreover, researchers found lower telemedicine use among patients without documented insurance vs. those with private insurance or Medicare (11.7% vs. 16.4%), those residing in rural and suburban areas vs. urban areas (9.8% and 12.9% vs. 17.7%) and patients residing in the lowest vs. highest socioeconomic status areas (10.6% vs. 23.6%).
Looking ahead
“Although there was some information regarding the uptake of telemedicine among patients with cancer, our study provides the most recent and comprehensive evaluation of trends and inequities in telemedicine use across sociodemographic characteristics,” Guadamuz said. “Finding inequities in the use of telemedicine is not surprising. For decades, cancer health equity researchers have demonstrated that marginalized populations are less likely to have access to novel technologies. What is important is that whenever a new technology is rolled out, policymakers and clinicians need to ensure patients, regardless of who they are or where they live, have equitable access.”
Future research should examine whether the use of telemedicine is associated with quality care, she added.
“For example, are patients who use telemedicine receiving guideline-concordant care? It will also be important to examine which types of practices are providing telemedicine more equitably to their patients. We can learn something from these clinics and bring it back to the rest of our network to support change in community-based oncology clinics that promotes equity,” Guadamuz said. “We also need to explore other social determinants of health characteristics that may be associated with telemedicine inequities. For example, patients who generally have less access to the internet in their homes, including Black patients and those in low socioeconomic settings and rural areas, are less likely to use telemedicine services. Is access to broadband services contributing to these observed inequities?”
For more information:
Jenny S. Guadamuz, PhD, can be reached at jguadamu@usc.edu.
Perspective
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Everett E. Vokes, MD
Telemedicine was not used much, if at all, before the pandemic, when it was used frequently. It remains an important tool to communicate with patients and it is a tool that can save patients time and transportation. It is, however, important to look at the digital divide and see who is able to participate and who is not.
In many ways, this is not new. Transportation to physically come to a clinic is not always easy for many disadvantaged patients and populations. It would, therefore, be nice if we can expand and learn how to use telehealth not in a crisis, but as part of regular care moving forward.
In July 2021, ASCO released standards and practice recommendations specific to telehealth in oncology. These standards were developed during the COVID-19 pandemic, when new rules for reimbursement for telehealth were implemented and made feasible for the first time. Amid the evolving health care delivery landscape, ASCO identified a need for specific standards in oncology that will fill gaps in the general telehealth guidance. These standards focus on which patients oncology practices should see via telehealth, virtual multidisciplinary cancer conference meetings, clinical trials via telehealth, and the role of advanced practice provider and allied health professionals.
There is much work that remains to be done, but in the meantime, this is a new way to communicate with our patients.
University of Chicago Medicine
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Guadamuz JS, et al. Abstract 6511. Presented at: ASCO Annual Meeting; June 3-7, 2022; Chicago.
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