In a study reported in a research letter in JAMA Oncology, Katz et al found that higher socioeconomic status was associated with greater use of telemedicine among patients with newly diagnosed cancers in the United States between January and August 2020.

As stated by the investigators, “The COVID-19 pandemic led to a decline of in-person clinical visits. Telemedicine increased during this time, but there was lower uptake in high-poverty areas. For patients newly diagnosed with cancer, a delay in care could cause irreversible harm; therefore, these patients may be especially motivated to use telemedicine to keep health-care appointments during the pandemic.”

Study Details

The study involved data from the Health Core Integrated Research Database on 16,006 patients with breast, lung, prostate, and colorectal cancers who were newly diagnosed between January 1 and August 31, 2020. The primary outcome measure was receipt of a telemedicine visit within 30 days of cancer diagnosis. Patients were categorized by socioeconomic status index scores into socioeconomic status quartiles, with 1 being the lowest and 4 the highest. A total of 8,483 patients (53%) were men and 7,891 (49%) were aged ≥ 65 years.

Key Findings

Overall, the rate of telemedicine visits increased from 0.4% in January 2020 to a peak of 54.0% in April. By April 2020, 66.9% of patients in the highest socioeconomic status index quartile had a telemedicine visit within 30 days of cancer diagnosis, compared with 47.4% to 48.6% in the lower three quartiles; patients in the highest socioeconomic status quartile exhibited the highest rate of telemedicine use in every subsequent study month.

On multivariate analysis, compared with the lowest socioeconomic status quartile, risk ratios (RRs) for use of telemedicine within 30 days of diagnosis were 1.31 (95% confidence interval [CI] = 1.17–1.47) in the highest quartile, 1.06 (95% CI = 0.94–1.19) in the third quartile, and 0.94 (95% CI = 0.83–1.07) in the second quartile.

Additional factors significantly associated with use of telemedicine within 30 days of diagnosis on multivariate analysis were:

• Lower likelihood for patients aged ≥ 65 years vs 18 to 64 years (RR = 0.89, 95% CI = 0.83–0.95)
• Higher likelihood for lung vs breast cancer (RR = 1.24, 95% CI = 1.13–1.37)
• Higher likelihood for Charlson comorbidity index of ≥ 3 vs 0 (RR = 1.26, 95% CI = 1.15–1.38)
• Lower likelihood for Midwestern (RR = 0.74, 95% CI = 0.66–0.82) and Southern regions (RR = 0.72, 95% CI = 0.64–0.80)
• Higher likelihood for Western region (RR = 1.13, 95% CI = 1.02–1.25) vs Northeastern region.

Additional multivariate analyses confirmed significant differences by socioeconomic status each month from March to July 2020. Risk ratios for the highest vs lowest socioeconomic status quartiles were 1.29 (95% CI = 1.01–1.66) in March and 1.59 (95% CI = 1.18–2.15) in July.

The investigators stated, “Disparities in cancer care and the resulting outcomes have been well described before the COVID-19 pandemic. Development of telemedicine capabilities has the potential to reduce these disparities by increasing access to consultations, second opinions, and follow-up visits. Yet the findings of the present study suggest that development of telemedicine capabilities is insufficient to reduce and, in fact, may widen disparities.”

Ronald Chen, MD, MPH, of the Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, is the corresponding author for the JAMA Oncology article.

Disclosure: For full disclosures of the study authors, visit jamanetwork.com.