Data Reveal Disparities in Telemedicine Use Among Patients With Cancer

The rise in telemedicine use during the COVID-19 pandemic may have widened disparities in cancer care, according to researchers.

In a group of patients starting first-line therapy at US cancer centers, researchers found that certain patients were less likely to use telemedicine during the first 2 years of the pandemic. 

Patients with lower socioeconomic status (SES), those without insurance, those living in rural or suburban areas, and Black patients were all less likely to use telemedicine. 

“[O]ne in 6 patients initiating cancer treatment used telemedicine services during the COVID-19 pandemic, but there were substantial inequities,” said Jenny S. Guadamuz, PhD, of Flatiron Health in New York, New York. “And while telemedicine use declined over the course of the pandemic, inequities persisted throughout.”

Dr Guadamuz presented these findings in a recent press briefing ahead of the 2022 ASCO Annual Meeting, where additional findings from the study are scheduled to be presented.

Dr Guadamuz and colleagues used the Flatiron Health database to study 26,788 patients who started first-line cancer therapy between March 2020 and November 2021 at roughly 280 cancer centers. The patients were followed through March 2022.

Overall, 16% of patients used telemedicine services during the study period. Telemedicine use was defined as having at least 1 telemedicine visit within 90 days after the start of first-line treatment. 

Roughly 25% of patients used telemedicine from March 2020 to May 2020. That percentage decreased to around 12% from September 2021 to November 2021. 

In an analysis adjusted for clinical characteristics, several factors were significantly associated with telemedicine use. 

The researchers found that telemedicine use decreased significantly as SES decreased. Compared with the highest SES quintile, the odds ratio (OR) for the lowest SES quintile was 0.39 (P <.01).

Telemedicine use was significantly less common among patients in suburban areas (OR 0.70; P <.01) or rural areas (OR, 0.51; P <.01) compared with patients in urban areas.  

Underinsured patients were just as likely to use telemedicine as well-insured patients (OR, 1.00), but patients with no insurance or unknown insurance were significantly less likely to use telemedicine (OR, 0.67; P <.01).

The researchers also found that Black patients were significantly less likely to use telemedicine compared with White patients (OR, 0.81, P <.01). There was no significant difference between Latinx and White patients (OR, 1.03), but patients of other or unknown race/ethnicity had significantly higher odds of using telemedicine when compared with White patients (OR, 1.15; P <.01).

“[T]he proliferation of telemedicine services may widen cancer care inequities if people of color and those living in historically marginalized areas do not have equitable access,” Dr Guadamuz said. “As a result, future research should examine additional characteristics that may be associated with telemedicine inequities; for example, high speed internet access. We should not assume that patients have equitable access … to the infrastructure necessary to use these services.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Guadamuz J, Wang X, Royce TJ, Calip GS. Racial and socioeconomic disparities in telemedicine use among US patients initiating cancer treatment during the COVID-19 pandemic. To be presented at ASCO 2022; June 3-7, 2022. Abstract 6511.

This article originally appeared on Cancer Therapy Advisor