Rural Cancer Survivors Report Low Telehealth Availability, Internet Access

A wide digital divide exists among Medicare beneficiaries who are cancer survivors, with urban survivors being more likely to use telehealth as compared with their rural counterparts, according to a new study.

The study shows that 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) as compared to those who lived in urban areas (63 percent).

Further, dual Medicare- and Medicaid-enrolled beneficiaries had lower probability of being offered telehealth as compared with non-dual enrollees,

Published in the Journal of Medical Internet Research, the study examined telehealth availability, technology ownership, and internet use among older cancer survivors. Researchers gathered data from the Medicare Current Beneficiary Survey COVID-19 Summer 2020 Supplement, a telephone survey of beneficiaries sponsored by the Centers for Medicare & Medicaid Services. The survey was conducted between June 10 and July 15, 2020.

For the analysis, researchers selected beneficiaries who reported previous non-skin cancer diagnoses. They examined four measures:

• Technology ownership, via the question "Do you own or use any of the following: desktop or laptop, smartphone, or tablet?"
• Internet access, via the question "Do you have access to the internet?"
• Internet use for communication, via the question "Have you ever participated in video or voice calls or conferencing over the internet, such as with Skype or FaceTime?"
• Telehealth availability, via the question "Does your usual provider offer telephone or video appointments, so that you don't need to physically visit their office or facility?"

Of the 2,044 cancer survivors included in the study, 57 percent were female, 41 percent were 75 years or older, and 79 percent were non-Hispanic white.

Over half (53 percent) said they used the internet for communication, according to the study. But like the findings regarding telehealth availability, rural survivors were less likely to own desktops, laptops, smartphones, or tablets (67 percent) versus urban cancer survivors (82 percent).

Rural cancer survivors were also less likely to have internet access (58 percent versus 79 percent) and less likely to participate in voice calls or conferencing (28 percent versus 46 percent).

These measures were further stratified along race lines. Compared with white cancer survivors, Hispanic and Black survivors had lower technology ownership, with 67 percent of Hispanic and 65 percent of Black survivors saying they owned a desktop, laptop, smartphone, or tablet, compared with 82 percent of white survivors.

Similarly, internet access and internet use for communication were lower among Black and Hispanic cancer survivors.

"Despite the potential of telehealth to meet the unique healthcare needs of cancer survivors (e.g., surveillance, comorbidities, primary and survivorship care), some patient groups face greater barriers to technology access," the study authors wrote. " These patterned differences in use and access underscore a need to engage multilevel interventions to mitigate the underlying barriers to telehealth use."

The researchers noted some potential interventions that the healthcare industry and policymakers could take, including developing new procedures to refer patients to community resources that can support technology access and telehealth literacy, ensuring the continued reimbursement of telehealth visits, and expanding broadband access.

In addition, clinicians can enhance telehealth capabilities and workflow by ensuring additional staff support during video log-on and follow-up processes.

The findings of this study are in line with research conducted on the use of telehealth in cancer care.

A study recently published in JAMA Oncology shows that newly diagnosed cancer patients with high socioeconomic status were more likely to have a telehealth visit in the 30 days following their diagnosis compared to patients with low socioeconomic status.