Telemedicine in Cancer Care: Not All Patients Can Access

Sharon Worcester, MA

May 27, 2022

The COVID pandemic pushed telemedicine forward as a safe, accessible, and more widely reimbursed approach to care delivery for patients with cancer, but uptake of telemedicine was plagued by inequities, a retrospective study suggests.

Before March 2020, only a very small percentage of patients with cancer used telemedicine services.

By November 2021, nearly 16% of patients initiating cancer treatment were using this approach.

However, certain groups were less likely to use telemedicine, in particular, patients who were Black, uninsured, did not live in cities, and were less affluent, noted lead author Jenny S. Guadamuz, PhD, a quantitative scientist at Flatiron Health and a postdoctoral research associate at the University of Southern California, Los Angeles.

The results are concerning because they suggest that telemedicine expansion could widen cancer care disparities, Guadamuz commented. Previous studies found racial disparities in care access and outcomes early on in the pandemic.

"These findings are critically important considering recent efforts to make coverage of telemedicine services permanent, instead of tied to the [Health and Human Services] 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."

This study was highlighted at a press briefing held in advance of the American Society of Clinical Oncology (ASCO) 2022 annual meeting, where it will be presented at a poster session (abstract 6511).

ASCO President Everett E. Vokes, MD, said telemedicine is "an important tool to communicate with patients” but that it is important consider the "digital divide.”

He also emphasized the need "to expand and learn to use telehealth not in a crisis but as part of our regular care moving forward." In July 2021, as telemedicine services were expanding, ASCO released practice recommendations specific to telehealth and oncology.

"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," he said in a press statement.

Study Details

For the study, Guadamuz and colleagues assessed telemedicine uptake by nearly 27,000 patients in a Flatiron electronic health record–derived deidentified database of patients who initiated treatment for any of 21 common cancers at about 280 community oncology clinics between March 2020 and November 2021.

They found that Black patients were significantly less likely than White patients to use telemedicine (13.2% vs 15.6%; odds ratio [OR], 0.82), as were patients without documented insurance, compared with those who were well insured (11.6% vs 16.4%; OR, 0.68).

Those in rural and suburban areas were less likely than those in urban areas to use telemedicine (9.7% and 13.0% vs 17.7%; ORs, 0.50 and 0.69, respectively), and those in less affluent vs more affluent areas were also less likely to use telemedicine (10.6% vs 23.6%, OR, 0.39).

Guadamuz noted that the differences remained statistically significant after adjusting for clinical characteristics and that racial inequities were seen across cancer types and over time.

Future work should assess other potential characteristics associated with telemedicine inequities, evaluate whether healthcare delivered via telemedicine is of similar quality as in-person services, and determine the types of practice that are providing telemedicine more equitably to their patients, she concluded.

American Society of Clinical Oncology (ASCO) 2022: Abstract 6511. Highlighted at a press briefing on May 26.

Sharon Worcester, MA, is an award-winning medical journalist based in Birmingham, Alabama, writing for Medscape, Mdedge and other affiliate sites. She currently covers oncology, but she has also written on a variety of other medical specialties and healthcare topics. She can be reached at sworcester@mdedge.com or on Twitter: @SW_MedReporter.

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