Telemedicine Can Make Cancer Care Inequities Worse

Deborah L. Ungerleider, MD, for Medscape

April 28, 2022

The study covered in this summary was published in ResearchSquare.com as a preprint and has not yet been peer-reviewed.

Key Takeaway

  • During the COVID-19 pandemic, financially distressed patients with cancer were frequent users of telemedicine, especially patients younger than 36 years and those with at least three comorbidities.

Why This Matters

  • Telemedicine can help with oncology care by facilitating symptom management, supervising chemotherapy, aiding in palliative care, and providing psychological support.

  • It can also help ease the financial toxicity that patients with cancer often face because of the high cost of therapy, high-deductible health plans, and high out-of-pocket expenses.

  • The rapid adoption of telemedicine might exacerbate existing inequities, so policy-level interventions are needed, as is the equitable delivery of telemedicine to vulnerable populations, such as patients with cancer.

Study Design

  • This cross-sectional analysis involved a sample of 627 English-speaking cancer patients at least 18 years of age who received social or financial aid from the Patient Advocate Foundation from July 2019 to April 2020.

  • All had completed a December 2020 survey, answering questions about their telemedicine experiences, including adoption, use, preferences, perceived advantages, and barriers to use of the service.

  • The researchers hypothesized that the use of telemedicine during the pandemic — the primary study outcome — might reduce the burden of financial toxicity, which can include an inability to manage out-of-pocket costs, psychological distress, and adaptive coping behaviors.

Key Results

  • Of the 67% of study participants who used telemedicine during the pandemic, 63% preferred video consults, 15% preferred audio consults, and 21% had no preference.

  • Telemedicine was deemed to be more affordable than in-person care by 29% of participants, to be more convenient by 28%, to provide quicker access to care by 17%, to provide access to experts outside of their geographic area by 8%, and to not interfere with the ability to work by 5%.

  • Barriers to use included poor internet connectivity, reported by 65% of participants, the lack of access to a device, reported by 19%, and discomfort or embarrassment about being on video, reported by 16%.

  • Concerns about telemedicine included quality of care, expressed by 46% of participants, worry that telemedicine is not a good substitute for in-person visits, expressed by 25%, discomfort with technology, expressed by 18%, and unease about security and privacy issues, expressed by 13%.

  • There was an association between the adoption of telemedicine and more comorbidities (= .0097). Patients with at least three comorbidities were more likely than those with cancer only to adopt telemedicine (odds ratio [OR], 1.79; 95% CI, 1.13 - 2.65). These patients had 36% more visits than those with cancer only; patients with one or two comorbidities had 21% more visits.

  • Patients 19 to 35 years of age were more likely to adopt telemedicine than those older than 75 years (OR, 6.07; 95% CI, 1.47 - 25.1). The younger group had 78% more telemedicine visits than the older group, and the middle-aged group — 36 to 55 years of age — had 52% more telemedicine visits than the older group.

Limitations

  • The cross-sectional, observational design of this study could have led to unmeasured confounding.

  • The researchers were unable to determine causality.

  • The study cohort — comprised of under-resourced, underserved patients — might not be representative of the overall cancer population.

  • The sample might have been skewed toward people who can navigate online and telephonic services and surveys.

  • The use of self-reported survey data could have introduced recall bias and imprecision.

  • Because the researchers were unable to conduct an analysis of survey nonresponders, they could not evaluate differences between study participants and nonparticipants.

Disclosures

  • The authors declare that no funds, grants, or other support were received during the preparation of the manuscript.

  • Researcher Anaeze Offodile, MD, has received research funding from Blue Cross Blue Shield, the University Cancer Foundation, the Rising Tide Foundation for Clinical Cancer Research, and the National Academy of Medicine, none of which are related to this research, and has received an honorarium from the Indiana University and University of Tennessee Departments of Surgery.

  • Researcher Gabrielle Rocque, MD, has received research funding from Genentech, Pfizer, and Carevive, and consulting fees from Pfizer.

This is a summary of a preprint research study, Determinants of Telemedicine Adoption Among Financially Distressed Patients With Cancer During the COVID-19 Pandemic: Insights From a Nationwide Survey, written by Abbas M. Hassan, MD, from the University of Texas M.D. Anderson Cancer Center, Houston, and colleagues, published on Research Square, and provided to you by Medscape. This study has not yet been peer-reviewed. The full text of the study can be found on ResearchSquare.com.

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