During the peak of the COVID-19 pandemic in early spring of 2020, fewer Black and Hispanic cancer patients in New York City used telehealth as compared with White patients, according to an analysis of data from one of the city's large hospital systems.
New York City was one of the early epicenters of the COVID-19 pandemic. Public concern about exposure and policies to "flatten the curve" led to abrupt curtailment of health care service use, including cancer. While innovative strategies to mitigate the disruption, including telemedicine, were put in place, the use of phone encounters and video visits was less accessible to minority populations.
"In a world where telehealth is needed because patients don't have in-person access to routine and follow-up cancer care-such as during the COVID-19 pandemic-it is important to recognize the gaps that exist among racial and ethnic minorities," said lead study author Cardinale B. Smith, MD, PhD, Associate Professor of Medicine and the Chief Quality Officer for Cancer Services at Mount Sinai Health System. "We know that many patients have not been seeking medical attention or continuing routine care because of fear about the virus."
Smith presented the results of the study at the 2020 ASCO Quality Care Symposium.
The Mount Sinai researchers evaluated data on race/ethnicity and visit type collected from electronic medical records of patients with cancer from the Mount Sinai Health System, which includes a National Cancer Institute-designated cancer center and eight ambulatory sites across New York City. They collected data from electronic medical records on all cancer patients with an in-person or telehealth visit during the peak of the pandemic between March 1 and June 1, 2020.
Key Findings
A total of 7,681 patients, mean age 65 years, had a telehealth visit during the study period. Three-quarters of the telehealth visits were video visits. Of these patients, 48 percent were White, 19 percent Black, 6 percent Hispanic, and 7 percent Asian. In comparison, of all patients seen at the health system in 2019, 42 percent were White, 23 percent Black, 14 percent Hispanic, and 7 percent Asian. In 2019, less than 1 percent of all patients used telehealth.
This study is limited to a single center in an urban environment and did not compare results to in-person visit frequency and did not capture the type of video platform used, she said. Additional research is needed to determine whether these results are generalizable beyond the population studied.
In conclusion, Smith said: "Telehealth utilization increased exponentially, but significantly decreased video visit utilization was seen among minorities. Awareness of these disparities is important."
Next Steps
The researchers are currently exploring ways to improve patient access to telehealth. They have obtained a grant that will allow them to provide in-home remote monitoring of patients. Individuals enrolled in the study will be provided with a Wi-Fi booster or enabler, depending on their home situation, and a tablet so they can have video visits with their clinician and participate in patient-reported outcome measures.
Significant disparities in the use of telehealth not only limit access to quality cancer care for these patients during the pandemic, but will continue to hinder patient care as telehealth use becomes more integrated into standard cancer care.
ASCO Expert Sonali M. Smith, MD, Professor of Medicine at the University of Chicago Medicine, commented: "Telehealth is an important part of cancer care, especially in the era of COVID-19. It is important for health care providers, patients, and caregivers to think about how we can help increase use of these kinds of services to ensure all patients can access high-quality cancer care."
Mark L. Fuerst is a contributing writer.