Gynecologic oncology patients are ready for telemedicine in routine care: results from a pre-COVID survey

Abstract

<h3>Objectives:</h3> We aimed to assess the telemedicine readiness and attitudes of gynecologic oncology patients with attention to groups at risk for difficulty in accessing care, such as increased distance to care and rural populations. <h3>Methods:</h3> Gynecologic oncology patients at all stages of disease and treatment (primary, recurrence, surveillance) were asked to complete an anonymous survey during in-person outpatient appointments at an academic comprehensive cancer center. Surveys were entered into RedCAP; SPSS was used for statistical analysis. This survey was conducted prior to the COVID-19 pandemic, before the introduction of telemedicine in this practice. <h3>Results:</h3> Of 180 patients approached, 170 completed the survey. Mean age was 59.6 years; 73.4% identified as White, 23.7% as Black, and 2.9% as other race. The majority of patients had ovarian cancer (41.2%), followed by endometrial (27.1%), cervical (20.6%), vaginal/vulvar (7.1%), and other (1.2%.) The majority of patients traveled greater than 50 miles for appointments (63.8%); these patients were more likely to be from rural counties and incurred a significantly higher cost for travel per visit ($60.77 vs $37.98, p=0.026.) The majority of patients expressed interest in using telemedicine appointments (75.7%) or a smartphone app (87.5%) as a component of their cancer care. Patients with difficulty attending appointments (88.9 vs 70.2%, p=0.02), or those from rural areas (88.7% vs 69.6%, p=0.03), were especially interested in telemedicine; those with both characteristics reported 100% interest in telemedicine. The majority of patients in both urban and rural counties had the ability to access the internet and telemedicine services from home, via smart phone or computer. Patients from rural and urban counties used the internet at similarly high rates (at least daily use, 79% vs 75%.) <h3>Conclusions:</h3> Telemedicine is acceptable and attractive to the majority of patients even prior to the COVID-19 pandemic, and may offer financial and logistical advantages for patients who live far from gynecologic oncology care. Overall, patients have high rates of internet use and express comfort with using technology for their healthcare. Disparities in cancer outcomes for rural patients, including survival and clinical trials enrollment, have been associated with increased distance to providers and difficulty accessing care. In our study, these patients were universally interested in telemedicine. Telemedicine should be incorporated into standard practice beyond the current COVID-19 pandemic to reduce healthcare disparities related to care access.