Telehealth Use for Cancer Care Surged During COVID-19, But Inequalities Remain

Telehealth visits for cancer care grew exponentially during the COVID-19 pandemic. However, despite its accessibility and uptick in use compared with prior to the pandemic, not all patients with cancer benefitted from the ease of access to their providers.

An analysis of electronic health records of 26,788 people aged 18 years and older who started cancer treatment between March 2020 and November 2021 identified that telehealth use was notably lower in Black patients when compared with their White counterparts (13.2% versus 15.6%, respectively). Additionally, patients without documented insurance were less likely than patients who had private insurance or were insured through Medicare to use telemedicine services during the same time period (11.7% versus 16.4%).

“The COVID-19 pandemic was associated with disruptions in healthcare delivery, including substantial declines in personal clinical visits,” lead study author Jenny S. Guadamuz, a postdoctoral research fellow in the USC Program on Medicines and Public Health in Los Angeles, said during a presentation of the data. “And as a result, many clinicians shifted to telemedicine services, and this was facilitated by federal and state regulations enacted early in the pandemic that expanded coverage and reimbursement for these services. And while there's some evidence suggesting that telemedicine uptake varied by social demographic factors such as age and region, there has been limited evaluation of inequities.”

The newly released data — which were presented during a press briefing ahead of the 2022 ASCO Annual Meeting, one of the largest cancer conferences in the world — demonstrated that despite the increased use in telemedicine among patients across more than 20 cancer types, inequities in its usage remain.

The largest disparity in telemedicine use was in people based on socioeconomic status —10.6% of patients living in the lowest socioeconomic status areas partook in telemedicine care compared with 23.6% of patients in areas with the highest socioeconomic status.

Guadamuz stressed that the inequities remained after the investigators adjusted for clinical characteristics — such as a patient’s age, sex, disease stage and health status.

“We found that black patients had lower odds of telemedicine of using telemedicine services in both unadjusted and adjusted models,” she said. “In other words, clinical characteristics do not account for these differences.”

And although their findings demonstrated that telemedicine use diminished as the pandemic progressed (25% from March to May 2020 versus 12% from Sept. to Nov. 2021), the inequities persisted.

“These findings are critically important considering recent efforts to make coverage for telemedicine services permanent instead of being tied to the HHS public health emergency declaration,” she said. “There (are) also efforts to increase reimbursement rates for telemedicine services by Medicare, several Medicaid programs and private insurers.”

The most important conclusion from these findings, according to Guadamuz, is that this disparity access and use to telemedicine services may further widen the inequity gap in cancer care.

For instance, she explained, it should not be assumed that every patient has equitable access to the necessary infrastructure — such as high-speed internet — to utilize telemedicine services.

Guadamuz noted that there are several things to keep in mind for future research. One thing she said was to see if there’s any differences in the timely receipt of necessary treatment between patients who received telemedicine care and those who received in-person care. Moreover, it is important to learn from the centers that have successfully utilized telehealth services.

“It'll be important to determine what types of practices are providing telemedicine more equitably to their patients, because we can learn from these clinics and bring it back to the rest of the of our network of clinics, therefore supporting more affordable care at community-based oncology clinics,” Guadamuz concluded.

Commenting on the study results, ASCO president Everett E. Vokes expressed how the findings are important for patients with cancer and physicians.

“(Telehealth) is a tool that can save patients time and transportation,” Vokes, who also serves as physician-in-chief at the University of Chicago Medicine and Biological Sciences, said. “Now it is important to then look at the digital divide. So, who can participate and who cannot participate? In many ways this is not new … it's not always easy to get either for disadvantaged patients and populations. But it would be nice as we hopefully expand and learn how to use telehealth not in a crisis but as part of our regular care moving forward, how to minimize those kinds of demands.”

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