Virtual visits among gynecologic oncology patients during the COVID-19 pandemic are accessible across the social vulnerability spectrum

Abstract

Objective The COVID-19 pandemic has quickly transformed healthcare systems with expansion of telemedicine. The past year has highlighted risks to immunosuppressed cancer patients and shown the need for health equity among vulnerable groups. In this study, we describe the utilization of virtual visits by patients with gynecologic malignancies and assess their social vulnerability. Methods Virtual visit data of 270 gynecology oncology patients at a single institution from March 1, 2020 to August 31, 2020 was obtained by querying a cohort discovery tool. Through geocoding, the CDC Social Vulnerability Index (SVI) was utilized to assign social vulnerability indices to each patient and the results were analyzed for trends and statistical significance. Results African American patients were the most vulnerable with a median SVI of 0.71, Asian 0.60, Hispanic 0.41, and Caucasian 0.21. Eighty-seven percent of patients in this study were Caucasian, 8.9% African American, 3.3% Hispanic, and 1.1% Asian, which is comparable to the baseline institutional gynecologic cancer population. The mean census tract SVI variable when comparing patients to all census tracts in the United States was 0.31 (range 0.00 least vulnerable to 0.98 most vulnerable). Conclusions Virtual visits were utilized by patients of all ages and gynecologic cancer types. African Americans were the most socially vulnerable patients of the cohort. Telemedicine is a useful platform for cancer care across the social vulnerability spectrum during the pandemic and beyond. To ensure continued access, further research and outreach efforts are needed.

Future of Teleoncology: Trends and Disparities in Telehealth and Secure Message Utilization in the COVID-19 Era

“…To the best of our knowledge, this is the first large study to describe disparities in use of telehealth and secure messages in medical hematology/oncology, across all types of cancers. Our findings were consistent with smaller prior studies that reported telehealth, securemessage, and EHR-portal enrollment-related disparities in various cancer-related disciplines, [9][10][11][12]28 and they demonstrate that such disparities persisted despite the major shifts toward telehealth since COVID-19 emerged. Our study focused on patients in California, one of the most racially and ethnically diverse state in the United States (by US Census measures 29 ), which outperforms most other states in government benchmarks of equity in health care.…”

“…The COVID-19 pandemic, which disproportionately affected historically underserved populations such as people of color, patients with lower income, and the elderly, 7 has brought to the forefront the national discussion on equity in health care. Although telehealth has long been viewed as one way to improve access to care, 8 early pandemic era studies show that underserved populations and historically marginalized groups use telehealth less frequently in primary care, 9 as well as in cancer care specialties including medical oncology, 9,10 gynecologic oncology, 11 and psychosocial oncology. 12 Secure message utilization for cancer care, even before the pandemic, lagged among older patients, African Americans, and those with lower education, lower earnings, or weak English proficiency.…”

Cancer Patients’ Experiences with Telehealth before and during the COVID-19 Pandemic in British Columbia

“…Similar to the results in Canada and elsewhere [ 18 ], we found that phone visits were more commonly used than video visits. This may be a result of different factors, such as organizations’ telehealth infrastructures, patient and clinician preferences, and patients’ demographics (i.e., age, race) including access to technology (e.g., phone vs computer) [ 27 , 38 ]. Phone visits do not require high digital literacy or internet accessibility, whereas video visits may require more IT support and higher network bandwidth, thus making the phone a more equitable and accessible option [ 39 ].…”

“…However, this rapid shift into telehealth has substantial negative consequences in terms of clinician-patient relationships, cybersecurity and technical aspects, and health care accessibility [ 25 ]. Cancer patients have expressed difficulty with cultivating a clinician-patient relationship, and clinicians have had concerns regarding the ability to conduct physical examinations and read physical cues in the patient’s body language [ 12 , 16 , 20 , 23 , 24 , 26 , 27 ]. Moreover, cancer patients preferred in-person appointments for receiving difficult news [ 18 , 20 , 24 ].…”

The utility of physical examination in ovarian cancer recurrence detection: a retrospective analysis informing virtual surveillance care

“…Financial toxicity is an emerging issue in cancer care, as patient financial burden has been associated with worse quality of life, lower patient satisfaction, and delaying or avoiding care 21–23. Telemedicine may offer a potential avenue to administer care while reducing patient burden and has previously been shown to be an accessible option for gynecologic oncology patients and for patients with advanced cancer in resource-limited settings 24 25…”