With the rapid acceleration of the spread of the COVID-19 virus in the United States in March 2020, telemedicine visits became more common for cancer care. However, in an evaluation of telemedicine inequities among patients with 21 common cancers, there were distinctly lower levels of telemedicine use by Black patients and those who were uninsured, lived in suburban or rural areas, and resided in a neighborhood with low socioeconomic status. The research will be presented by Guadamuz et al at the 2022 ASCO Annual Meeting (Abstract 6511).
About the Study
The health records used in the study were from 26,788 patients who were age 18 years or older and who started first-line cancer treatment between March 2020 and November 2021 (with follow-up through March 2022) at community-based cancer centers. The investigators looked at differences in the number of telemedicine visits across race/ethnicity, insurance coverage, rural vs suburban vs urban residence, and neighborhood socioeconomic status. They found that 15.9% of patients in the study used telemedicine services within 90 days (about 3 months) after initiation of systemic cancer treatment.
The data for the study was derived from electronic records from Flatiron Health. Before March 2020, only a very small percentage of patients with cancer used telemedicine services, according to research published by Katz et al in JAMA Oncology.
Key Findings
Black patients were less likely to use telemedicine services than White patients (13.2% vs 15.6%, respectively) during the first 2 years or so of the COVID-19 pandemic. Telemedicine use was lower among patients without documented insurance than those with private insurance or Medicare (11.7% vs 16.4%). Patients in rural (9.8%) and suburban areas (12.9%) were less likely to use telemedicine services than patients in urban areas (17.7%). Patients living in the lowest socioeconomic status areas were less likely to use telemedicine than those in the highest areas (10.6% vs 23.6%).
“Our study provides the most recent and comprehensive evaluation of trends and inequities in telemedicine use across many sociodemographic characteristics. While telemedicine may expand access to specialty care, the proliferation of these services may widen cancer care disparities if vulnerable populations do not have equitable access,” said lead study author Jenny S. Guadamuz, PhD, a quantitative scientist at Flatiron Health.
Next Steps
The study researchers emphasized that it will be important to evaluate whether the use of telemedicine is associated with quality care.
The researchers hope the lessons learned from this study are imparted to cancer care centers nationwide with the goals of:
- Ensuring that Centers for Medicare and Medicaid Services (CMS) policies that allowed the proliferation of telemedicine services are made permanent and not just tied to the COVID-19 public health emergency declaration.
- Improving access to health insurance—one of the greatest determinants of telemedicine use.
- Making sure that technologies are accessible for those with low tech literacy and limited English proficiency, which is distinct from health literacy.
Perspective
“Telemedicine can improve access to timely cancer care, but as this study points out, telemedicine must be available equitably, so that every patient can access the care they need and deserve,” said ASCO President Everett E. Vokes, MD, FASCO.
ASCO Statement on Telehealth
In July 2021, JCO Oncology Practice published ASCO’s standards and practice recommendations specific to telehealth in oncology.
The standards were developed during the COVID-19 pandemic, when new rules around reimbursement for telehealth had recently been implemented in the United States. Amid the evolving health-care delivery landscape, ASCO identified a need for specific standards for oncology that would fill gaps in the general telehealth guidance. The standards focus on which patients oncology practices should see via telehealth, virtual multidisciplinary cancer conference meetings, clinical trials via telehealth in oncology, and the role of advanced practice providers and allied health professionals.
Disclosure: This study received funding from Flatiron Health. For full disclosures of the study authors, visit coi.asco.org.
