Background Oncology rapidly shifted to telemedicine in response to the COVID‐19 pandemic. Telemedicine can increase access to healthcare, but recent research has shown disparities exist with telemedicine use during the pandemic. This study evaluated health disparities associated with telemedicine uptake during the COVID‐19 pandemic among cancer patients in a tertiary care academic medical center. Methods This retrospective cohort study evaluated telemedicine use among adult cancer patients who received outpatient medical oncology care within a tertiary care academic healthcare system between January and September 2020. We used multivariable mixed‐effects logistic regression models to determine how telemedicine use varied by patient race/ethnicity, primary language, insurance status, and income level. We assessed geospatial links between zip‐code level COVID‐19 infection rates and telemedicine use. Results Among 29,421 patient encounters over the study period, 8,541 (29%) were delivered via telemedicine. Several groups of patients were less likely to use telemedicine, including Hispanic (adjusted odds ratio [aOR] 0.86, p = 0.03), Asian (aOR 0.79, p = 0.002), Spanish‐speaking (aOR 0.71, p = 0.0006), low‐income (aOR 0.67, p < 0.0001), and those with Medicaid (aOR 0.66, p < 0.0001). Lower rates of telemedicine use were found in zip codes with higher rates of COVID‐19 infection. Each 10% increase in COVID‐19 infection rates was associated with an 8.3% decrease in telemedicine use (p = 0.002). Conclusions This study demonstrates racial/ethnic, language, and income‐level disparities with telemedicine use, which ultimately led patients with the highest risk of COVID‐19 infection to use telemedicine the least. Additional research to better understand actionable barriers will help improve telemedicine access among our underserved populations.

Individuals diagnosed with colorectal adenomas with high-risk features during screening colonoscopy have increased risk for the development of subsequent adenomas and colorectal cancer. While US guidelines recommend surveillance colonoscopy at 3 years in this high-risk population, surveillance uptake is suboptimal. To inform future interventions to improve surveillance uptake, we sought to assess surveillance rates and identify facilitators of uptake in a large integrated health system. We utilized a cohort of patients with a diagnosis of ≥ 1 tubular adenoma (TA) with high-risk features (TA ≥ 1 cm, TA with villous features, TA with high-grade dysplasia, or ≥ 3 TA of any size) on colonoscopy between 2013 and 2016. Surveillance colonoscopy completion within 3.5 years of diagnosis of an adenoma with high-risk features was our primary outcome. We evaluated surveillance uptake over time and utilized logistic regression to detect factors associated with completion of surveillance colonoscopy. The final cohort was comprised of 405 patients. 172 (42.5%) patients successfully completed surveillance colonoscopy by 3.5 years. Use of a patient reminder (telephone, electronic message, or letter) for due surveillance (adjusted odds = 1.9; 95%CI = 1.2–2.8) and having ≥ 1 gastroenterology (GI) visit after diagnosis of an adenoma with high-risk features (adjusted odds = 2.6; 95%CI = 1.6–4.2) significantly predicted surveillance colonoscopy completion at 3.5 years. For patients diagnosed with adenomas with high-risk features, surveillance colonoscopy uptake is suboptimal and frequently occurs after the 3-year surveillance recommendation. Patient reminders and visitation with GI after index colonoscopy are associated with timely surveillance completion. Our findings highlight potential health system interventions to increase timely surveillance uptake for patients diagnosed with adenomas with high-risk features.

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INTRODUCTION: There have been a myriad of efforts to address suboptimal colorectal cancer (CRC) screening rates in the United States (US). Individuals with high-risk colon polyps detected during screening colonoscopy have 2- to 5-fold increased risk for the future development of CRC; however, there are few efforts directed towards optimizing risk reduction in this group. We examined surveillance uptake for patients with high-risk polyps in a large, academic healthcare system. METHODS: \We identified a cohort of patients: 1) age 50–75; 2) with a colonoscopic diagnosis of high-risk adenoma (HRA; 1 adenoma >1 cm, adenoma with villous histology, adenoma with high-grade dysplasia, or 3 or more adenomas) between January 2013 and January 2016; and 3) regular primary care (PC) at UCLA Health. We collected information from the electronic health record (EHR) on demographics, polyp histology, colonoscopy completion, and office visits. We determined the proportion of patients that completed surveillance colonoscopy each year and used Student's t-tests and chi-square tests to evaluate univariate associations between patient characteristics and colonoscopy completion. RESULTS: Our cohort included 203 individuals with HRA. Mean age was 62.5 (SD = 7.6), 62.6% were male, and 75.3% were White (Table 1). There were 153 (75.4%) patients who did not complete surveillance within 3 years. Surveillance completion increased from 24.6% to 40.4% by 3.5 years. 110 (54.2%) completed surveillance by the end of 5 years (Table 2). In all, 202 (99.5%) patients had documentation of a PC visit and 165 (81.3%) had documentation of a GI visit before surveillance was due. There were 121 (59.6%) patients with a documented history of adenoma in the EHR problem list. Patients with ≥1 GI visit after HRA diagnosis (165, 81.3%) were more likely to complete surveillance than patients without a GI visit after HRA diagnosis (38, 18.7%) (P < 0.001). CONCLUSION: Overall uptake of surveillance colonoscopy was low at 3 years for patients with HRA. There was notable improvement in follow-up by 3.5 years; however, adherence remained suboptimal at 40%. Clinical implications of this delay are unknown. Documentation of adenoma history was low. Individuals with HRA represent a group that has been largely neglected in CRC prevention/control research and that warrants evidence-based strategies to ensure appropriate follow-up to reduce CRC burden.