Highly Privileged Cancer Patients Get Access to Telehealth Sooner

Though telehealth use among cancer patients skyrocketed early in the COVID-19 pandemic, uptake was not uniform across socioeconomic groups, according to a study published in JAMA Oncology.

Most patients in the highest socioeconomic status index quartile (66.9 percent) had a virtual visit within 30 days of cancer diagnosis, compared with about 48 percent of patients in the lower index quartiles.

The study leveraged data from the HealthCore Integrated Research Database, which comprises single-payer administrative claims information for around 60 million people enrolled in Medicare Advantage and commercial health plans.

Researchers analyzed data from 16,006 patients with newly diagnosed breast, lung, prostate, and colorectal cancer between Jan. 1 and Aug. 31, 2020. Of the study participants, 53 percent were men, and 50.7 were between 18 and 64 years.

They found that the rate of telemedicine visits increased from 0.4 percent in January 2020 to 54 percent in April 2020.

Researchers use a socioeconomic status index score to examine variations in telehealth use, which was calculated using seven area-level social determinants of health variables, as developed by the Agency for Healthcare Research and Quality. The index scores were analyzed as quartiles.

Not only did newly diagnosed cancer patients in higher socioeconomic status index quartiles get access to telehealth sooner than those in the lower ones, but the former also maintained the highest rate of telemedicine use in every subsequent month.

"Development of telemedicine capabilities has the potential to reduce these disparities by increasing access to consultations, second opinions, and follow-up visits," study authors concluded, "Yet the findings of the present study suggest that the development of telemedicine capabilities is insufficient to reduce and may widen disparities."

But there are certain limitations of the study, including that the disparities in telemedicine use could be attributed to patient preferences for in-person versus virtual visits rather than inequalities in oncologic care.

A recent poll shows that a third of older Americans said they were worried that receiving care via telehealth was not as effective as a traditional in-person visit.

Further, cost plays a role, with research showing that patients who preferred telehealth were likely to switch to in-person care if it was cheaper.

The current study also noted that differences in telehealth use might be attributable to patient access to and comfort with technology.

A study published in the Journal of Medical Internet Research in January showed that a vast digital divide exists among Medicare beneficiaries who are cancer survivors. Though 62 percent of cancer survivors covered by Medicare reported that their usual provider had telehealth services available, rural survivors reported lower telehealth availability (53 percent) than those who lived in urban areas (63 percent).

Further, Spanish-speaking cancer patients had 29 percent lower odds of using telehealth compared to English speakers, another recent study revealed.