Accessibility of Telehealth services for cancer care at cancer hospital in the United States.

Abstract

6535 Background: The COVID-19 pandemic has dramatically accelerated the availability of telehealth services for patients with cancer. However, little national cross-sectional data is available to inform potential gaps in access. We aimed to characterize overall access to and trends in telehealth availability for new cancer care patients at hospitals across the United States. Methods: We performed a cross sectional secret-shopper study to evaluate the availability of telehealth services for new patients for three major cancer types—colorectal, breast, and skin cancer—at Commission on Cancer accredited hospitals during the period of April to November 2020. American Hospital Association and Center for Medicare and Medicaid Service databases were queried to determine hospital characteristics. We described hospital variation in access to telehealth services using descriptive statistics. Univariable and multivariable logistic regression were used to identify factors associated with telehealth availability. Results: Of 334 successfully contacted facilities, 248 (74%) offered new patient telehealth services for at least one cancer type. However, access differed by cancer site: telehealth availability for new patients with skin, colorectal, and breast cancer was 47%, 42%, and 38%, respectively. Of the facilities sampled, 47% offered telehealth for one cancer type, 40% for two cancer types, and 14% for all three cancer types. Rates of any telehealth access among the cancer types ranged from 61% at Community Cancer Programs to 100% at NCI Designated Programs. In multivariable logistic regression, facility type was significantly associated with telehealth access while factors such as bed size, ownership, and volume were not significantly associated. Conclusions: Although access to telehealth services for patients with cancer has increased, overall gaps in access remain. Within facility differences in telehealth access imply opportunities to better align services within institutions, though further investigation is warranted as these offerings mature.[Table: see text]

Virtual Care and Electronic Patient Communication During COVID-19: Cross-sectional Study of Inequities Across a Canadian Tertiary Cancer Center

“…This future analysis is required, as previous work has suggested that marginalized patients participate in video visits less often than nonmarginalized peers due to limitations of technological access and literacy [ 15 ]. Second, we found differential access to and use of email and VC by clinic type, echoing findings of other studies [ 16 ]. While differential VC use by clinic type may be attributable to clinical reasoning regarding the added benefit of in-person oncologic assessment to VC-amenable biochemical and/or radiographic surveillance in certain clinical contexts, differential access to email and survey responsiveness by clinic type are agnostic to provider preferences and may be indicative of unaccounted intersectional digital divides among subpopulations with lower socioeconomic status [ 28 ].…”

“…Some have noted the potential benefits of VC and email for enhancing equitable care [10][11][12], including increased health care utilization among racialized minorities and those with travel restrictions. Others have expressed concerns about digital divides in access to VC due to structural marginalization [13][14][15][16][17], particularly among marginalized populations known to be more prone to adverse oncologic outcomes [18,19]. These concerns underscore the importance of investigating inequities following the adoption of digital health tools and addressing their impact on oncologic care [20,21].…”

Lessons for Oncology From the COVID-19 Pandemic

“…Rates of telemedicine use varied across oncology subspecialties, ranging from 38% in breast oncology to 47% for cutaneous oncology. 34 Specialties such as cardiology, gastroenterology, and neurology that often help manage novel therapies and their toxicities also experienced substantial increases in virtual care. While rates of telemedicine use have declined some since the beginning of the pandemic, they remain higher than prepandemic levels.…”

“…A 2020 survey of oncology practices showed that 100% of National Cancer Institute–designated cancer centers and 61% of community practices offered virtual visits. Rates of telemedicine use varied across oncology subspecialties, ranging from 38% in breast oncology to 47% for cutaneous oncology 34 . Specialties such as cardiology, gastroenterology, and neurology that often help manage novel therapies and their toxicities also experienced substantial increases in virtual care.…”