During the peak of the COVID-19 pandemic, fewer Black and Hispanic patients with cancer used telehealth (including phone encounters and video visits) compared to White patients, according to findings from an analysis of data from New York City hospitals. Significant disparities in the use of telehealth not only limit access to quality cancer care for these patients during the pandemic, but will continue to hinder patient care as the use of telehealth becomes more integrated into standard cancer care. The study will be presented as part of the virtual 2020 ASCO Quality Care Symposium by Cardinale B. Smith, MD, PhD, and colleagues (Abstract 87).
“In a world where telehealth is needed because patients don’t have in-person access to routine and follow-up cancer care—such as during the COVID-19 pandemic—it is important to recognize the gaps that exist among racial and ethnic minorities,” said Dr. Smith, Associate Professor of Medicine and Chief Quality Officer for Cancer Services at Mount Sinai Health System, in a statement. “We know that many patients have not been seeking medical attention or continuing routine care because of fear about the virus.”
Cardinale B. Smith, MD, PhD
Study Findings
The researchers evaluated data on race/ethnicity and visit type collected from electronic medical records of patients with cancer from the Mount Sinai Health System, which includes a National Cancer Institute–designated cancer center and eight ambulatory sites across New York City. Researchers looked at the use of telehealth between March 1 and June 1, 2020.
A total of 7,681 patients had a telehealth visit during the study period. Of these patients, 48% were White; 19%, Black; 6%, Hispanic; and 7%, Asian. In comparison, of all patients seen at the health system in 2019, 42% were White; 23%, Black; 14%, Hispanic; and 7%, Asian. In 2019, less than 1% of all patients used telehealth.
Among those patients utilizing video visits, 50% patients were White; 17%, Black; 8%, Asian; and 5%, Hispanic. Among those patients utilizing phone encounters, 43% patients were White; 23%, Black; 7%, Hispanic; and 6%, Asian.
This study is limited to one health system and additional research is needed to determine whether these results are generalizable beyond the population studied.
The authors are currently exploring ways to improve patient access to telehealth and obtained a grant that will allow them to provide in-home remote monitoring of patients. Patients enrolled in the study are provided with a WiFi booster or enabler, depending on their home situation, and a tablet so they can have video visits with their clinician and participate in patient-reported outcome measures.
The study authors concluded, “During the COVID-19 pandemic, our utilization of telehealth increased exponentially. There were significant disparities observed in the use of telehealth, with Black, Hispanic, and Asian patients having less utilization. These findings are important as telehealth use will now become more integrated into standard oncologic care, and it is likely that we will have a second or third wave of COVID-19 infections. Future work to understand the determinants of these disparities and interventions are needed.”
Disclosure: For full disclosures of the study authors, visit coi.asco.org.
