Gynecologic oncology patients living in rural areas less likely to utilize telemedicine services during the COVID-19 pandemic (054)

Abstract

Objectives: The COVID-19 pandemic is an unprecedented event in the era of modern medicine and has resulted in a rapid shift in clinical care delivery to incorporate more telemedicine services. While there is a well-recognized need for the integration of telehealth into gynecologic oncology care, there are concerns about limitations of its use regarding access to and ability to use requisite technology. The purpose of this study was to characterize gynecologic oncology patients who utilized telemedicine as part of their cancer care during the pandemic in order to determine potential barriers and facilitators of telemedicine use.Methods: A single-institution retrospective chart review was performed of patients who participated in at least one telemedicine visit from March 1 to September 30, 2020, at an NCI-designated cancer center. Demographic factors were compared between telemedicine users and non-users using Fisher’s exact test for categorical values and the Wilcoxon rank-sum test for continuous variables.Results: A total of 2238 patients were seen during the study period. Of which, 193 patients participated in telemedicine visits, and 2045 patients did not participate in any telemedicine visit with gynecologic oncology providers (Table 1). The median age was 63 years in both groups, and 65% of users were older than 60 years versus 62% of non-users. There were no significant differences with respect to race and primary language; the majority were Caucasian and English-speakers. There was no difference in terms of insurance status; about 50% in each group were privately insured. Among the telemedicine users, 97% had private insurance or Medicaid/Medicare, compared to 93% of non-users. Among users, the median distance of the patient’s residence from the cancer center was 21 miles, with 36% living 50 miles or further and 28.5% living in rural zip codes as designated by the Federal Office of Rural Health Policy. Among non-users, the median distance was 24.5 miles, with 37% living 50 miles or further and 38% living in rural zip codes. The odds of using telemedicine for patients living in rural zip codes was 34.6% less than for patients living in non-rural zip codes (Odds Ratio: 0.654, 95% CI: 0.473-0.906).Conclusions: Telemedicine provides an important opportunity to reduce unnecessary patient exposure to healthcare settings and has the potential to decrease the financial toxicity and treatment burden associated with cancer care. Our findings suggest that telemedicine at our institution was accessible to patients of a wide range of ages, including a large percentage of older adults. While 37% of gynecologic oncology patients seen during this period lived in rural areas, we found that the odds of utilizing telemedicine were significantly lower among patients who lived in rural areas compared to those living in non-rural areas (p=0.0101). This highlights the importance of identifying barriers rural patients face in utilizing telemedicine services and developing strategies to improve their access.